背景:这项研究调查并比较了疗效,安全,辐射暴露,经皮放射胃造口术(PRG)的两种方式的经济补偿:多层螺旋CT活检模式(MS-CTBM)引导和透视引导(FPRG)。目的是提供有关优化放射学辅助胃造口术程序的见解。
方法:我们对2018年1月至2024年1月在单个中心进行的PRG程序进行了回顾性分析。根据所使用的成像方式将程序分为两组。我们比较了病人的人口统计,干预参数,并发症发生率,和程序时间。根据瑞士门诊医疗服务的关税结构(TARMED)评估了经济补偿。使用Fisher精确检验和Mann-WhitneyU检验确定统计学差异。
结果:研究队列包括133例患者:55例MS-CTBM-PRG和78例FPRG。该队列包括35名女性和98名男性,平均年龄64.59岁(±11.91)。在有效剂量的方式之间观察到显着差异(MS-CTBM-PRG:10.95mSv±11.43vs.FPRG:0.169mSv±0.21,p<0.001)和手术时间(MS-CTBM-PRG:41.15min±16.14vs.FPRG:28.71分钟±16.03,p<0.001)。FPRG的主要并发症明显更频繁(10%vs.0%在MS-CTBM-PRG中,p=0.039,φ=0.214)。最初需要较高的单位数的MS-CTBM引导的PRG,以将手术持续时间减少10分钟。财务比较显示,只有4%的MS-CTBM引导的PRG获得了相当于最频繁的可比检查的报销,根据TARMED。
结论:根据我们的回顾经验,单中心研究,使用MS-CTBM执行PRG,与FPRG相反,尽管主要并发症的发生率较低,但目前在具有挑战性的病例中是合理的。然而,需要进一步精心设计的前瞻性多中心研究来确定疗效,安全,以及这两种模式的成本效益。
BACKGROUND: This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic
gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted
gastrostomy procedures.
METHODS: We conducted a retrospective analysis of PRG procedures performed at a single center from January 2018 to January 2024. The procedures were divided into two groups based on the imaging modality used. We compared patient demographics, intervention parameters, complication rates, and procedural times. Financial compensation was evaluated based on the tariff structure for outpatient medical services in Switzerland (TARMED). Statistical differences were determined using Fisher\'s exact test and the Mann-Whitney U test.
RESULTS: The study cohort included 133 patients: 55 with MS-CT BM-PRG and 78 with FPRG. The cohort comprised 35 women and 98 men, with a mean age of 64.59 years (±11.91). Significant differences were observed between the modalities in effective dose (MS-CT BM-PRG: 10.95 mSv ± 11.43 vs. FPRG: 0.169 mSv ± 0.21, p < 0.001) and procedural times (MS-CT BM-PRG: 41.15 min ± 16.14 vs. FPRG: 28.71 min ± 16.03, p < 0.001). Major complications were significantly more frequent with FPRG (10% vs. 0% in MS-CT BM-PRG, p = 0.039, φ = 0.214). A higher single-digit number of MS-CT BM-guided PRG was required initially to reduce procedure duration by 10 min. Financial comparison revealed that only 4% of MS-CT BM-guided PRGs achieved reimbursement equivalent to the most frequent comparable examination, according to TARMED.
CONCLUSIONS: Based on our experience from a retrospective, single-center study, the execution of a PRG using MS-CT BM, as opposed to FPRG, is currently justified in challenging cases despite a lower incidence of major complications. However, further well-designed prospective multicenter studies are needed to determine the efficacy, safety, and cost-effectiveness of these two modalities.