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目的 探讨内镜在临床窦道型慢性创面探查中的应用价值.方法 2017年12月-2018年3月,笔者单位创面修复中心门诊收治27例符合入选标准的窦道型慢性创面患者,对其28个窦道型慢性创面进行前瞻性自身前后对照研究.清理窦口后,用刻度尺测量窦口口径,用探针根据手感肓测窦道深度,另借助止血钳在肉眼直视下用探针测量窦道可见纵深.5 min后,在内镜监视下深入探针并结合手感测量窦道深度,另用内镜观察窦道并深入探针测量内镜视野下窦道可见纵深.完成上述探查后,于窦道内灌注对比剂欧乃派克350行CT检查测量窦道深度.计算CT检查测得的窦道深度和刻度尺测量的窦口口径的比值(下称窦道深口比)、常规检查(只用探针测量)和内镜检查(内镜监视下用探针测量)测得窦道深度与CT检查测得窦道深度的偏差率(下称窦道测深偏差率)、常规检查和内镜检查测得窦道可见纵深与CT检查测得窦道深度的偏差率(下称窦道可见纵深偏差率).对数据行配对t检验,另对窦道深口比与常规检查和内镜检查的窦道测深偏差率和窦道可见纵深偏差率的相关性进行Pearson相关分析.结果 本组创面的窦道深口比为1～32(8 ±7).本组创面常规检查的窦道测深偏差率和窦道可见纵深偏差率分别为(19±14)％、(79±1 8)％,均明显大于内镜检查的(9±9)％、(25±25)％(t=3.837、13.626,P＜0.01).本组创面窦道深口比与常规检查的窦道测深偏差率以及常规检查、内镜检查的窦道可见纵深偏差率均呈明显正相关(r =0.514、0.585、0.651,P＜0.01),而窦道深口比与内镜检查的窦道测深偏差率无明显相关(r=0.113,P＞0.05).结论 采用内镜可以较常规检查获得更准确的临床窦道型慢性创面形态数据,能更大范嗣地观察该类创面.

Objective To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic.Methods Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial.After being cleaned,the diameter of the opening of sinus tract was measured with a rule.A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation,and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps.Five minutes later,a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation.Afterwards,the sinus tract was observed with endoscope,and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract.After completion of the above exploration,the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth.The following indicators were calculated:the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract),the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract),the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed).Data were processed with paired t test.Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope.Results The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8 ± 7).The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19 ± 14)％ and (79 ± 18)％,respectively,both obviously larger than (9±9)％ and (25±25)％ by endoscope (t =3.837,13.626,P ＜0.01).Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method,and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r =0.514,0.585,0.651,P ＜0.01).However,there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r =0.113,P ＞ 0.05).Conclusions Compared with the conventional method,application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.