软性内镜与硬性内镜在不同形态窦道型慢性创面临床检查中的应用价值

陶贵录; 刘英开; 唐佳俊; 马先; 黄丽芳; 周景祺; 吴芳依; 奥布力阿西木·牙库普; 王晗琦; 管皓楠; 董叫云; 陆树良

doi:10.3760/cma.j.cn501120-20200318-00179

软性内镜与硬性内镜在不同形态窦道型慢性创面临床检查中的应用价值

doi: 10.3760/cma.j.cn501120-20200318-00179

1.
上海交通大学医学院附属瑞金医院创面修复中心　　200025
2.
上海交通大学医学院附属瑞金医院放射科　　200025

基金项目:

国家卫计委重大疾病防治科技行动计划创伤修复专项 2017ZX01001

详细信息

通讯作者:
陆树良，Email：13901738685@139.com

计量
- 文章访问数: 236
- HTML全文浏览量: 76
- PDF下载量: 22
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-18

Application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes

1.
Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2.
Radiology Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Funds:

Special Program for Trauma Repair of Science and Technology Action Plan of Major Disease Prevention and Treatment of National Health Committee of China 2017ZX01001

More Information

Corresponding author: Lu Shuliang, Email: 13901738685@139.com

摘要

摘要: 目的探讨软性内镜与硬性内镜在不同形态窦道型慢性创面临床检查中的应用价值。方法采用回顾性观察性研究方法。2019年1月1日—12月23日，上海交通大学医学院附属瑞金医院创面修复中心收治46例符合入选标准的窦道型慢性创面患者，其中男、女各23例，年龄18~81（48±21）岁。入院时，行CT造影及三维重建了解创面窦道形态并分类，记录“CT造影检查测得的创面窦道长度”（下称参考长度）；分别采用硬性内镜和软性内镜检查并测量创面窦道长度。将含明显弯曲、无明显弯曲窦道的创面分别归入曲线组、直线组，计算各组创面中软性内镜或硬性内镜检查测得的“创面窦道长度与参考长度的偏差率”（下称长度偏差率），比较各组创面中软性内镜与硬性内镜检查测得的长度偏差率及二者与参考长度偏差率（0）之间的差异。对数据行配对样本t检验、Wilcoxon符号秩和检验。结果 CT造影及三维重建显示，本组患者创面窦道形态分为管状（36/46）、片状（4/46）、棒槌状（4/46）、不规则状（2/46）4种，其中，管状进一步分为I型（23/36）、L型（4/36）和Y型（9/36）。含I型管状、片状和棒槌状窦道的创面归为直线组（31/46），含Y型管状、L型管状和不规则状窦道的创面归为曲线组（15/46）。在直线组中，硬性内镜、软性内镜检查测得的长度偏差率均为0。在曲线组中，软性内镜检查测得的长度偏差率为0（0，0.58%），明显低于硬性内镜检查测得的41.18%（31.68%，48.41%），Z=-3.408，P<0.01；硬性内镜检查测得的长度偏差率（40±19）%明显高于参考长度偏差率（t=8.343，P<0.01），软性内镜检查测得的长度偏差率与参考长度偏差率相近（Z=-1.342，P>0.05）。结论相较于硬性内镜，软性内镜在窦道型慢性创面的临床检查中能更大范围地观察该类创面的内部特征，尤其是对于弯曲型窦道型慢性创面的探查具有明显优势，这种方法的推广将有利于窦道型慢性创面的诊断及治疗。
- 内窥镜 /
- 生物形态 /
- 治疗，临床研究性 /
- 窦道型慢性创面 /
- 软性内镜 /
- 硬性内镜 /
- CT造影
Abstract: Objective To explore the application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes. Methods A retrospective observational study was conducted. From January 1 to December 23, 2019, a total of 46 patients with chronic sinus tract wounds, who met the inclusion criteria were admitted to the Wound Healing Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 23 males and 23 females, aged 18-81 (48±21) years. On admission, computer tomography (CT) imaging and three-dimensional reconstruction were performed to examine the shapes of wound sinus tract and classify the wounds, with the lengths of wound sinus tract by CT imaging examination (hereinafter referred to as reference lengths) recorded. The lengths of wound sinus tract were examined and measured by rigid endoscopy and flexible endoscopy. The wounds with and without obviously curved sinus tract were classified into curve group and linear group respectively, and the deviation rates between the lengths of wound sinus tract measured by flexible endoscopy or rigid endoscopy and the reference lengths (hereinafter referred to as deviation rates of lengths) in each group were calculated. The difference between the deviation rates of lengths examined by flexible endoscopy and rigid endoscopy and the differences between the above two and the deviation rate of reference lengths (0) in each group were compared. Data were statistically analyzed with paired sample t test and Wilcoxon signed rank sum test. Results CT imaging and three-dimensional reconstruction showed that there were 4 types of wound sinus tract, including tubular (36/46), lamellar (4/46), club-mallet (4/46), and irregular (2/46) shape. Tubular wounds were further divided into type I (23/36), type L (4/36), and type Y (9/36). Wounds with type I tubular, lamellar, and club-mallet sinus tract were classified into linear group (31/46), while those with type Y tubular, type L tubular, and irregular sinus tract were classified into curve group (15/46). In linear group, the deviation rates of lengths examined and measured by rigid endoscopy and flexible endoscopy were 0. In curve group, the deviation rate of lengths examined and measured by flexible endoscopy was 0 (0, 0.58%), which was significantly lower than 41.18% (31.68%, 48.41%) examined and measured by rigid endoscopy, Z=-3.408, P<0.01; the deviation rate of lengths examined and measured by rigid endoscopy (40±19)% was significantly higher than the deviation rate of reference lengths (t=8.343, P<0.01), while the deviation rate of the lengths examined and measured by flexible endoscopy was similar to the deviation rate of reference lengths (Z=-1.342, P>0.05). Conclusions Compared with rigid endoscopy, flexible endoscopy can observe the internal characteristics of chronic sinus tract wounds in a wider range in the clinical examination of this kind of wound, especially for the exploration of curved chronic sinus tract wounds. The promotion of this method will be conducive to the diagnosis and treatment of chronic sinus tract wounds.
- Endoscopes /
- Organism forms /
- Therapies, investigational /
- Chronic sinus tract wound /
- Flexible endoscopy /
- Rigid endoscopy /
- CT imaging
所有作者均声明不存在利益冲突

HTML全文

所有作者均声明不存在利益冲突

参考文献(21)

[1]	FonderMA,LazarusGS,CowanDA,et al.Treating the chronic wound:a practical approach to the care of nonhealing wounds and wound care dressings[J].J Am Acad Dermatol,2008,58(2):185-206.DOI: 10.1016/j.jaad.2007.08.048.
[2]	FlanaganM.Wound measurement: can it help us to monitor progression to healing?[J].J Wound Care,2003,12(5):189-194.DOI: 10.12968/jowc.2003.12.5.26493.
[3]	李中华,王海琴,杨波,等.不同方法治疗患者慢性窦道的效果比较[J].中华烧伤杂志,2014,30(1):72-75.DOI: 10.3760/cma.j.issn.1009-2587.2014.01.020.
[4]	周丽青,彭峥嵘,杨敏,等.窦道伤口护理的研究进展[J].全科护理,2017,15(15):1821-1825.DOI: 10.3969/j.issn.1674-4748.2017.15.010.
[5]	FerreiraMC,TumaP,CarvalhoVF,et al.Complex wounds[J].Clinics (Sao Paulo),2006,61(6):571-578.DOI: 10.1590/s1807-59322006000600014.
[6]	GrothierL,PardoeA.Chronic wounds: management of healing and wellbeing[J].Br J Nurs,2013,22(12):S24, S26-30.DOI: 10.12968/bjon.2013.22.Sup8.S24.
[7]	JørgensenLB,SørensenJA,JemecGB,et al.Methods to assess area and volume of wounds - a systematic review[J].Int Wound J,2016,13(4):540-553.DOI: 10.1111/iwj.12472.
[8]	ShamloulN,GhiasMH,KhachemouneA.The utility of smartphone applications and technology in wound healing[J].Int J Low Extrem Wounds,2019,18(3):228-235.DOI: 10.1177/1534734619853916.
[9]	付小兵.慢性难愈合创面防治理论与实践[M].北京:人民卫生出版社,2011:505.
[10]	唐佳俊,陆树良,马先,等.内镜在临床窦道型慢性创面探查中的应用价值[J].中华烧伤杂志,2018,34(6):365-369.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.010.
[11]	黄顺荣,徐胜.微创外科的发展现状与技术应用[J].微创医学,2017,12(2):157-161.DOI: 10.11864/j.issn.1673.2017.02.01.
[12]	刘洪臣.微创医学与口腔微创医学[J].口腔颌面修复学杂志,2017,18(2):65-68.DOI: 10.3969/j.issn.1009-3761.2017.02.001.
[13]	黄德珍,徐向阳,李权,等.探究不同剂量CT扫描技术在臀部窦道造影患者中的应用价值[J].中国CT和MRI杂志,2016,14(6):115-117.DOI: 10.3969/j.issn.1672-5131.2016.06.037.
[14]	SavageJM,JefferySLA.Use of 3D photography in complex-wound assessment[J].J Wound Care,2013,22(3):156, 158-160.DOI: 10.12968/jowc.2013.22.3.156.
[15]	马先,陶贵录,奥布力阿西木·牙库普,等.内窥镜联合造影检查在邻近体腔的慢性窦道创面诊疗中的临床获益研究[J].中华烧伤杂志,2019,35(6):441-445.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.008.
[16]	鲁晋,王亮,张永存,等.烧伤创面测量技术进展[J].中国医学装备,2016,13(9):131-133,134.DOI: 10.3969/J.ISSN.1672-8270.2016.09.040.
[17]	程琳难愈窦道性创面的三维空间立体重建——新的难愈窦道性创面评估方法的建立太原山西医科大学2016DOI:10.7666/d.D01089508 程琳.难愈窦道性创面的三维空间立体重建——新的难愈窦道性创面评估方法的建立[D].太原:山西医科大学,2016.DOI:10.7666/d.D01089508.
[18]	甘露,张红,林伶,等.进口与国产腹腔镜设备与器械下活体动物实验训练效果比较[J].中国内镜杂志,2015,21(5):459-464.
[19]	鲁艳国产内窥镜耗材研发项目管理杭州浙江工业大学2016 鲁艳.国产内窥镜耗材研发项目管理[D].杭州:浙江工业大学,2016.
[20]	徐勇勇,刘丹红.观察性研究方法与医院资料的统计分析[J].中国医院统计,2004,11(4):293-297.DOI: 10.3969/j.issn.1006-5253.2004.04.002.
[21]	张雯雯,周正东,管绍林,等.电子内窥镜的研究现状及发展趋势[J].中国医疗设备,2017,32(1):93-98.DOI: 10.3969/j.issn.1674-1633.2017.01.025.

1 窦道型慢性创面CT造影及三维重建形态。1A.I型管状；1B.L型管状；1C.Y型管状；1D.片状；1E.棒槌状；1F.不规则状

注：各图中左下角红框中图片为箭头指示处创面形态的放大图

下载: 全尺寸图片幻灯片

2 不同方法检查患者压力性窦道型慢性创面情况。2A.骶尾部偏左侧可见约1.0 cm×0.5 cm皮肤破溃，创周色白，窦口未见明显渗出；2B.CT造影及三维重建检查显示窦道呈L型管状，长度为5.04 cm；2C.硬性内镜检查测得窦道长度为2.50 cm；2D.软性内镜检查测得窦道长度为4.95 cm

下载: 全尺寸图片幻灯片