Clinical Analysis Of 256-slice Spiral CT Three-dimensional Reconstruction In The Diagnosis And Preoperative Planning Of Tracheobronchial Foreign Body

ObjectiveTo analyze the application of 256-slice spiral CT(256-SSCT)three-dimensional reconstruction technology and to evaluate the preoperative planning in the diagnosis of tracheobronchial foreign body(TFB).MethodsSixty patients with definite or suspicious TFB history who visited our hospital from June 2014 to September 2017 were divided into the 256-SSCT reconstruction group and the X-ray group,with 30 patients in each group.Among them,the 256-SSCT reconstruction group was diagnosed by 3d airway reconstruction using 256-SSCT,and all of them were verified by rigid bronchoscopy.For the confirmed cases with TFB,the measurement tools of our hospital's picture archiving and communication system(PACS)were used to accurately measure the size and characteristics of the airway and foreign bodies according to the three-dimensional airway images and airway axial position images provided by the three-dimensional reconstruction of the airway with 256-SSCT.According to these data,the appropriate type of rigid bronchoscope and the appropriate foreign body forceps were selected,and the correct risk assessment was made for each confirmed case,as well as the reasonable perioperative treatment,and the correct surgical timing and method were selected.All the 30 patients in the X-ray group had definite or suspicious foreign body history.The rigid bronchoscope model was selected according to the age of the patients,and the foreign body forceps were roughly selected according to the foreign body history.The risk could not be correctly evaluated,and the risk could only be roughly estimated according to the symptoms of the patients.The diagnostic rate,misdiagnosis rate,missed diagnosis rate,operation time,operation success rate and postoperative complication rate were compared between the two groups.Results1.Preoperative examination and diagnosisAmong the 30 patients in the 256-SSCT reconstruction group,29 patients were diagnosed with foreign body,and 1 patient had no foreign body,and the accuracy of diagnosis confirmed by rigid bronchoscopy was 100%.In the X-ray group,30 patients were diagnosed with foreign bodies in 18 cases and 12 without foreign bodies.The diagnostic accuracy of empirical diagnosis was 60%(18/30),the rate of misdiagnosis(false positive rate)was 6.7%(2/30),and the rate of missed diagnosis(false negative rate)reached 33.3%(10/30),X~2=15,P<0.001,and the difference was statistically significant.2.Preoperative planning resultsSelection of rigid bronchoscope model:among the 30 patients in the 256-ssct reconstruction group,9 patients selected the rigid bronchoscope model based on preoperative CT value,which was inconsistent with age,accounting for 30%,and the appropriate rate was 100%.Among the 30 patients in the X-ray group,10 patients were found to have inappropriate model during the operation,with the inappropriate rate of33.3%,X~2=12,P<0.001,and the difference was statistically significant.Selection of foreign body forceps:the appropriate rate of foreign body forceps was 100%in the256-ssct reconstruction group,and the inappropriate rate was 0.In the X-ray group,there were 23 cases of inappropriate foreign body forceps,the inappropriate rate was 88.5%,and the appropriate rate was only 11.5%,X~2=44.09,P<0.001,and the difference was statistically significant.Preoperative risk assessment and perioperative treatment:there were 2 cases of bilateral bronchial foreign bodies in the 256-SSCT reconstruction group,and the preoperative risk assessment was critical cases,and immediate surgery was given.The preoperative risk assessment of 2 patients with tracheal foreign bodies was between severe and critical,and emergency surgery was performed.General cases 3 cases,elective surgery;In severe cases,22 cases were treated with anti-inflammatory symptomatic treatment before surgery.The X-ray group could judge the severity of the patient according to the clinical symptoms,could not accurately assess the preoperative risk,and could not properly select the timing and mode of surgery.3.Comparison of intraoperative and postoperative effectsThe mean duration of surgery in the 256-SSCT reconstruction group was 13.5 6.3min,and that in the X-ray group was 33.5 10.3 min.The mean duration of surgery in the two groups was compared,t=15.2,P<0.05,and the difference was statistically significant.In the 256-SSCT reconstruction group,29 patients were diagnosed with foreign bodies,and 29 of them were successfully operated,with a 100%success rate and 0%failure rate.In the X-ray group,there were 26 cases of foreign body confirmed by rigid bronchoscopy,including 22 cases of successful surgery,3 cases of foreign body residue,1 case of foreign body not removed,the success rate of surgery was 84.5%,and the failure rate was 15.4%.The success rate of the two groups was compared,X~2=1.18,P<0.05,and the difference was statistically significant.The complication rate was 24.1%(7/29)in the 256-SSCT reconstruction group,and 69.2%(18/26)in the X-ray group,X~2=2.77,P<0.05.ConclusionsThe diagnosis of TFB by three-dimensional reconstruction of 256-SSCT airway issimple,rapid,non-invasive and accurate,which has important clinical application value.Using 256-SSCT three-dimensional airway reconstruction for preoperativeexamination can make accurate??preoperative risk assessment,preoperative planning and perioperative treatment,which can effectively improve the success rate of surgery,reduce the risk of surgery and reduce the complications of surgery.