CAJ | 학술논문

目的分析近5年小儿软组织异物诊疗经验,探讨临床新策略.方法我院连续诊治≤16岁软组织不透X线异物患儿165例,均经X线平片确认,40例加行CT(9例增强)扫描及仿真局部解剖评价.采用C臂机X线透视引导下经皮异物钳取术,评价其疗效.结果异物长径1～40 mm,短径1～5 mm,包括各类铁屑、铁钉、铁丝、缝针、断针及玻璃碎片等,位于四肢、颈部、胸腹部、盆部等软组织内.76例(76/165,46.06％)患儿接受介入治疗,完全治愈73例(73/76,96.05％),部分治愈2例(2/76,2.63％),失败1例(1/76,1.32％).CT仿真局部解剖成像准确揭示了异物与毗邻结构解剖位置关系及血管损伤并发症,指导了治疗方法与钳取路径的选择.未出现需特殊治疗的出血、感染、神经损伤等并发症.结论X线透视导向经皮异物钳取术是一项微创、安全、有效的小儿软组织不透X线异物的介入治疗方法,但玻璃异物、伴或不伴血管损伤的大血管旁异物需谨慎；术前CT仿真局部解剖成像有助于复杂异物的定位、介入路径选择与治疗风险评估.
목적분석근5년소인연조직이물진료경험,탐토림상신책략.방법 아원련속진치≤16세연조직불투X선이물환인165례,균경X선평편학인,40례가행CT(9례증강)소묘급방진국부해부평개.채용C비궤X선투시인도하경피이물겸취술,평개기료효.결과이물장경1～40 mm,단경1～5 mm,포괄각류철설、철정、철사、봉침、단침급파리쇄편등,위우사지、경부、흉복부、분부등연조직내.76례(76/165,46.06％)환인접수개입치료,완전치유73례(73/76,96.05％),부분치유2례(2/76,2.63％),실패1례(1/76,1.32％).CT방진국부해부성상준학게시료이물여비린결구해부위치관계급혈관손상병발증,지도료치료방법여겸취로경적선택.미출현수특수치료적출혈、감염、신경손상등병발증.결론X선투시도향경피이물겸취술시일항미창、안전、유효적소인연조직불투X선이물적개입치료방법,단파리이물、반혹불반혈관손상적대혈관방이물수근신；술전CT방진국부해부성상유조우복잡이물적정위、개입로경선택여치료풍험평고.
Objective To evaluate the past 5 years' clinic experience of diagnosis and treatment of the pediatric soft-tissue foreign body (STFB),and to probe new strategies for its clinical management.Methods Totally 165 consecutive children with small radiopaque STFB were involved.All the children were diagnosed with X-rays.CT (enhanced CT in 9 children)and virtual anatomy imaging (VAI) were performed in 40 children.Percutaneous foreign body forceps removal guided with C-arm video-fluoroscopy was performed and the effect was evaluated.Results The longest dimension of STFB ranged from 1 mm to 40 mm,and the shortest dimension ranged from 1 mm to 5 mm,including scrap-iron,broken iron nails and needles,and glass pieces embedded in soft tissues under surface of the limbs,neck,chest,abdomen and pelvis.Seventy-six (76/165,46.06 ％) children received interventional therapy,and 73 were completely cured (73/76,96.05 ％),2 were partially cured (2/76,2.63 ％),and 1 was failed (1/76,1.32 ％).VAI accurately depicted STFB closely to large vessels even associated vascular complication with local large hematomas or pseudoaneurysms,helped to select the treatment methods and the forceps removal roads.Hematoma,infection,neural damages and other serious complications did not occur during and after operation.Conclusion Video-fluoroscopy-guided percutaneous foreign body forceps removal is minimally invasive,safe and effective for small radiopaque STFBs,but may not suitable for the one very close to large blood vessels with or without vascular injuries complications.Preoperative CT VAI is helpful to locate STFB within complicated anatomic structures,selecting optimal intervention pathway and assessing the risk of intervention.