FDG-PET／CT在心脏外科术后慢性胸骨正中切口感染临床诊治中的首次应用

摘要

目的：评价氟代脱氧葡萄糖（FDG）正电子发射计算机断层显像（PET／CT）对心脏术后慢性胸骨正中切口感染的定性、定位诊断价值，以及对手术清创的引导价值。方法：选择2015年2月—2015年12月在复旦大学附属中山医院整形外科诊治的21例心脏外科手术后慢性胸骨正中切口感染的患者。21例患者均在术前1周行PET／CT检查。根据PET／CT及CT影像对21例患者的胸骨感染范围、是否存在肋软骨炎及感染肋软骨的位置进行判断，并与术中诊断结果进行比较，评价PET／CT对慢性胸骨正中切口感染的定性及定位诊断价值。根据PET／CT结果，引导手术清创，术后随访6～16个月，评价慢性胸骨正中切口感染的清创重建手术效果。结果：21例慢性胸骨正中切口感染患者中，20例为胸骨骨髓炎、18例为纵隔感染、9例为肋软骨炎。PET／CT诊断胸骨正中切口感染的准确性均为100％。PET／CT对肋软骨炎定位诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为85．71％、99．74％、96．00％、98．99％、98．81％，其中敏感度、阴性预测值及准确度均优于C T （P值分别为0．002、0．008、0．01）。慢性胸骨正中切口感染患者 PET／CT 引导下1次清创重建术后的治愈率为85．7％。结论：PET／CT对心脏术后慢性胸骨正中切口感染的定位及定性诊断准确，效果显著优于CT ，可用于引导手术清创。%Objective:To evaluate the qualitative and localization diagnostic value of PET/CT in chronic sternal median incision infection after heart surgery and the guiding function of PET/CT image in debridement .Methods:Twenty‐one patients with chronic sternal median incision infection admitted to our hospital from February 2015 to December 2015 underwent PET/CT examinations within one week prior to surgery were selected .Detection of extent of sternal wound infection and localization diagnoses of costal chondritis were conducted by using PET/CT and CT ,and the results were compared with the diagnosis results during surgery .The qualitative and localization diagnostic value of PET/CT in chronic sternal median incision infection were evaluated .Debridement was guided by the PET/CT images .Patients were followed up for 6‐16 months after operation ,and the debridement and reconstructive surgery effect on chronic sternal median incision infection was evaluated . Results:There were 20 cases of sternal osteomyelitis ,18 cases of mediastinitis ,and 9 cases of costal chondritis .Accuracies of PET/CT in above diagnoses were all 100% .Sensitivity ,specificity ,positive predictive value ,negative predictive value ,and accuracy of PET/CT in localizing involved costal cartilages were 85 .71% ,99 .74% ,96 .00% ,98 .99% ,and 98 .81% , respectively .Sensitivity , negative predictive value , and accuracy of PET/CT in localizing involved costal cartilages were significantlyhigherthanthoseofCT(Pvalueswere0.002,0.008,and0.01).Curerateofpatientswithcostalchondritisafter first debridement operation was 85 .7% .Conclusions:PET/CT is of high accuracy in qualitative diagnosis and localization compared with CT in chronic sternal median incision infection after heart surgery , which is promising in guidance of debridement operation .