Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University.
J Trauma Acute Care Surg. 2012 Jan;72(1):302-5. doi: 10.1097/TA.0b013e31822c1c50.
Radiopaque foreign bodies (RFBs) retained in soft tissue are a common clinical problem. Image-guided extraction plays a great role in this realm. We describe our experience in the management of RFBs imbedded deeply in soft tissue using a percutaneous less-invasive technique under fluoroscopic guidance.
In all, 76 patients with 251 RFBs including gun pellets (n = 223), needle fragments (n = 4), and irregular metallic splinters (n = 24) underwent percutaneous extraction of RFBs with the modified technique, which consists of: (1) percutaneously gaining access to the RFB using an 18-gauge needle, several tapered dilators, and an outer cannula and (2) grasping and withdrawal of RFB using a forceps through the cannula. The following periods were 6 months to 6 years.
The direct distance between RFB and skin was from 2.5 cm to 8.5 cm (average 4.8 cm). Every RFB was successfully removed with technique success rate of 100%. The RFBs measured 0.2 cm to 3.0 cm in length and 0.1 cm to 0.5 cm in width. The procedural time and exposure time of X-ray for each RFB extraction were 8 minutes to 15 minutes and 1 minute to 4 minutes (mean, 10 minutes and 2 minutes, respectively). The radiation doses for each RFB and patient were 15.64 mGy to 62.56 mGy and 15.64 mGy to 500.48 mGy (mean, 30.26 mGy and 72.47 mGy, respectively). Blood lead concentration decreased to normal one month after the procedures in four patients with preprocedural high level. No complications were observed during the procedures and the following periods.
Percutaneous extraction of RFBs from deep soft tissue with the present technique is safe, effective, and minimally invasive.
软组织内留存的不透射线异物（RFB）是一种常见的临床问题。影像引导下的取出术在这方面发挥了重要作用。我们描述了在透视引导下使用经皮微创技术从深部软组织中取出 RFB 的经验。
共有 76 例患者（251 个 RFB）接受了经皮 RFB 取出术，其中包括弹丸（n=223）、针碎片（n=4）和不规则金属碎片（n=24）。使用改良技术经皮穿刺进入 RFB，该技术包括：（1）使用 18 号针头、几个锥形扩张器和外套管经皮进入 RFB；（2）通过套管用钳子抓住并取出 RFB。随访时间为 6 个月至 6 年。
RFB 与皮肤的直接距离为 2.5 厘米至 8.5 厘米（平均 4.8 厘米）。每个 RFB 均成功取出，技术成功率为 100%。RFB 长度为 0.2 厘米至 3.0 厘米，宽度为 0.1 厘米至 0.5 厘米。每个 RFB 取出术的操作时间和 X 射线曝光时间分别为 8 分钟至 15 分钟和 1 分钟至 4 分钟（平均 10 分钟和 2 分钟）。每个 RFB 和患者的辐射剂量分别为 15.64 毫戈瑞至 62.56 毫戈瑞和 15.64 毫戈瑞至 500.48 毫戈瑞（平均 30.26 毫戈瑞和 72.47 毫戈瑞）。在四个术前高血铅水平的患者中，术后一个月血铅浓度降至正常。在手术过程中和随访期间均未观察到并发症。
使用本技术从深部软组织中取出 RFB 是安全、有效和微创的。
