增强磁共振检查在开胸术后纵隔炎诊治中的应用

doi:10.3877/cma.j.issn.1674-0785.2022.07.017

目的

探讨增强磁共振（MRI）检查在开胸术后纵隔炎诊治中的临床应用价值。

方法

收集2013年6月~2017年12月北京大学第一医院收治的30例开胸术后纵隔炎患者的临床资料，以2016年1月之后收治的15例作为研究组，在增强MRI检查指导下进行清除手术及创面负压治疗；将2016年1月之前收治的15例患者作为对照组，进行传统的经验性清创手术治疗。比较2组患者的手术次数及平均住院天数等指标。

结果

应用增强磁共振检查之后，开胸术后纵隔炎患者的平均手术次数分别为研究组2.8±0.8次，对照组3.6±1.0次（P=0.036）；平均住院天数研究组38.4±10.1天，对照组50.4±15.3天，差异有统计学意义（P=0.028）。

结论

应用增强磁共振检查指导开胸术后纵隔炎患者的清创治疗可显著减少手术次数及住院天数，临床应用价值较高。

关键词: 开胸术后纵隔炎, 磁共振, 负压技术

Objective

To evaluate the clinial application value of enhanced MRI in the treatment of post-sternotomy mediastinitis.

Methods

The clinical data of 30 patients with post-sternotomy mediastinitis treated in Peking University First Hospital from June 2013 to December 2017 were collected. 15 patients who were admitted after January 2016 were selected as the study group and underwent debridement and negative pressure wound therapy under the guidance of enhanced MRI. 15 patients admitted before January 2016 were used as the control group for empirical debridement. Indicators such as the number of operations and average hospitalization days of the two groups were compared.

Results

The average number of operations in patients with post-sternotomy mediastinitis was 2.8±0.8 in the study group and 3.6±1.0 in the control group (P=0.036); The average length of stay in the study group was 38.4±10.1 days and the control group was 50.4±15.3 days (P=0.028).

Conclusion

Using enhanced MRI to guide the debridement of post-sternotomy mediastinitis can significantly reduce the number of operations and hospital stay, and has high clinical application value.

Key words: Post-sternotomy mediastinitis, Enhanced MRI, Negative pressure wound therapy

图1 2组患者的治疗流程比较

表1 研究组第一次MRI结果统计（第二次MRI结果除软组织水肿外其余阳性表现均转阴）

序号	软组织病变			胸骨病变		关节病变	肋软骨变
序号	水肿	脓肿	窦道	骨髓水肿	骨髓炎	关节病变	肋软骨变
1	+	-	-	-	-	-	-
2	+	-	-	+	+	-	-
3	+	-	-	+	-	-	+
4	+	-	-	+	-	-	+
5	+	+	+	+	-	+	-
6	+	+	+	+	+	+	+
7	+	+	+	+	+	-	+
8	+	-	-	+	+	+	+
9	+	-	-	+	+	+	+
10	+	+	+	+	-	-	-
11	+	+	+	+	+	-	+
12	+	+	+	+	-	-	+
13	+	-	+	+	-	-	+
14	+	-	-	+	-	-	+
15	+	-	-	+	+	+	+

表1 研究组第一次MRI结果统计（第二次MRI结果除软组织水肿外其余阳性表现均转阴）

序号	软组织病变			胸骨病变		关节病变	肋软骨变
序号	水肿	脓肿	窦道	骨髓水肿	骨髓炎	关节病变	肋软骨变
1	+	-	-	-	-	-	-
2	+	-	-	+	+	-	-
3	+	-	-	+	-	-	+
4	+	-	-	+	-	-	+
5	+	+	+	+	-	+	-
6	+	+	+	+	+	+	+
7	+	+	+	+	+	-	+
8	+	-	-	+	+	+	+
9	+	-	-	+	+	+	+
10	+	+	+	+	-	-	-
11	+	+	+	+	+	-	+
12	+	+	+	+	-	-	+
13	+	-	+	+	-	-	+
14	+	-	-	+	-	-	+
15	+	-	-	+	+	+	+

图2 研究组及对照组CRP水平变化曲线注：横轴为天数，纵轴为CRP水平，单位mg/L

图3 患者男性63岁，冠状动脉旁路移植术后24个月。增强MRI检查发现有纵膈内脓肿形成，囊壁明显强化。白色箭头为冠状面显示下脓腔，黑色箭头为矢状面显示下脓腔，图a为冠状位增强影像，图b为矢状面影像

图4 患者女性73岁，冠状动脉旁路移植术后2个月。增强MRI检查发现有纵膈内窦道形成，上图为平扫MRI窦道显示不清，下图为增强MRI检查，可见窦道壁明显强化，走形显示清晰。白色箭头为窦道走行。图a为冠状面平扫影像，图b为冠状面增强后影像

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Analysis of the application of enhanced MRI guided sequential therapy in the treatment of post-sternotomy mediastinitis

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Analysis of the application of enhanced MRI guided sequential therapy in the treatment of post-sternotomy mediastinitis