介入超声治疗肝脓肿临床价值研究

目的 总结分析超声引导下经皮肝穿刺治疗肝脓肿的临床应用价值.方法 29例肝脓肿患者,在超声定位引导下经皮肝穿刺,采取穿刺抽吸、置管引流的方法,进行脓液的抽吸、引流,以灭滴灵反复冲洗;同时给予静脉滴注抗生素、加强支持疗法等综合措施.结果 在超声引导下经皮肝穿刺抽吸或置管引流脓液后3天内体温逐步降至正常,脓腔缩小,穿刺后平均住院天数14.4天.结论 超声引导下经皮肝穿刺治疗肝脓肿,操作简便,疗效肯定,避免了传统的开腹手术,是临床首选的治疗方法.     

超声引导下经皮穿刺置管引流治疗肝脓肿的临床疗效及预后观察

目的观察超声引导下经皮穿刺置管引流(PCD)治疗肝脓肿的临床疗效及预后。方法选择2016年5月～2018年5月我科收治的肝脓肿患者48例,随机分为观察组和对照组各24例。对照组实施超声引导下经皮穿刺针单纯抽吸治疗,观察组实施PCD治疗,比较两组患者治疗效果、临床症状消失时间、住院时间及并发症。结果观察组疼痛消失时间、脓肿消失时间、体温恢复时间及住院时间均短于对照组,差异有统计学意义(P<0.05);两组治疗总有效率及并发症发生率比较,差异无统计学意义(P>0.05)。结论在肝脓肿中应用PCD治疗效果较好,可有效缓解患者临床症状,且并发症少,安全性较高。     

超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿

目的:探讨超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿的临床应用价值。方法:对细菌性肝脓肿患者39例51个病灶实施超声引导下经皮穿刺,5cm的肝脓肿直接穿刺抽吸治疗,5cm的肝脓肿置管引流。结果:27例脓肿5cm者,1次抽吸治愈率85.2%(23/27),2次抽吸治愈率占14.8%(4/27)。12例脓肿5cm者行置管引流治疗,患者均在穿刺引流24～48h后体温降至正常,临床症状改善。结论:超声引导穿刺置管引流治疗细菌性肝脓肿安全、简便、有效,可作为临床治疗细菌性肝脓肿的首选方法。     

超声引导下经皮肝穿刺治疗细菌性肝脓肿的临床价值

目的评价超声引导下经皮肝穿刺治疗细菌性肝脓肿的临床应用价值。方法对临床确诊为细菌性肝脓肿的49例患者进行超声引导下经皮肝穿刺治疗,其中22例行单纯细针抽吸术（抽吸组）,26例行置管引流术（置管组）,1例抽吸术后1周脓腔无明显缩小而行置管引流术（抽吸＋置管组）;同时配合静脉抗炎、全身支持治疗。结果超声引导下经皮肝穿刺细针抽吸或置管引流治疗后,患者体温恢复正常、白细胞计数恢复正常及脓腔消失时间分别为（2.8±0.6）d、（3.2±0.5）d、（14.6±4.2）d。所有患者均无并发症,术后3个月复查超声脓腔均消失,超声引导下经皮肝穿刺治疗细菌性肝脓肿的治愈率为100%。结论超声引导下经皮肝穿刺细针抽吸和置管引流术具有简便经济、创伤小、并发症低、治愈率高等优点,成为细菌性肝脓肿首选治疗方法。     

B超引导下经皮经肝穿刺引流治疗肝脓肿43例的护理

目的探讨超声引导经皮穿刺置管引流冲洗治疗肝脓肿的临床应用价值及护理。方法对43例肝脓肿患者,45个病灶行超声引导经皮穿刺置管引流。结果 43例患者完全治愈,无护理并发症。结论超声引导经皮穿刺置管引流抽吸冲洗治疗肝脓肿,方法简单,安全有效,创伤小,可取代外科手术治疗肝脓肿。细致周到的护理是治疗成功的重要保证。     

超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果观察

研究超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果。纳入老年细菌性肝脓肿患者94例,根据随机数字表法均分为切开组和超声组。切开组采用细菌性肝脓肿切开置管引流治疗,超声组采用超声引导下经皮穿刺置管引流术治疗。比较两组总有效率、体温复常时间、脓腔消失时间、血象复常时间、住院时间及并发症发生率的差异。超声组总有效率显著高于切开组(P0.05);超声组相较于切开组体温复常时间、脓腔消失时间、血象复常时间、住院时间更短(P0.05);超声组相较于切开组并发症发生率更低(P0.05)。超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果确切,可有效促进体温和血象恢复正常,减少并发症发生,缩短脓腔消失时间和住院时间,值得推广运用。     

实时超声引导下经皮穿刺置管引流治疗细菌性肝脓肿

本文报告细菌性肝脓肿13例,单发9例,多发4俐,均在使用抗菌素的同时,在实时超声引导下经皮经肝穿刺抽吸或置管引流进行治疗。经穿刺抽脓治疗者7例,置管引流治疗者2例,另4例经穿刺1～3次后转手术切开引流治疗。本组无并发症出现。作者认为实时超声引导下经皮经肝抽吸或置管引流术对病人痛苦少,疗效高,安全可靠,是治疗细菌性肝脓肿的首选方法。     

B超引导下穿刺置管引流术治疗肝脓肿22例临床分析

目的 探讨超声引导下经皮肝穿刺抽脓或置管引流在细菌性肝脓肿的临床应用价值。方法对22例细菌性肝脓肿通过超声引导确定后进行穿刺抽脓或置管引流,其中4例行穿刺抽脓1次,21例行置管引流。结果22例穿刺、置管全部获成功,平均疗程20d（10～42d）。术后无腹腔内出血、气胸、脓胸及严重腹腔感染等并发症。结论B超引导下肝脓肿穿刺置管引流术具有简便、安全、住院时间短、费用少,并发症低的优点,可用于治疗大多数肝脓肿。     

超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的效果观察

目的探讨给予细菌性肝脓肿老年患者超声引导下经皮穿刺置管引流术治疗的临床效果。方法从本院2017年4月～2018年6月收治细菌性肝脓肿老年患者中选取68例,随机分为对照组和观察组各34例。对照组给予切开置管引流治疗,观察组予超声引导下经皮穿刺置管引流术治疗,观察两组患者治疗效果。结果术后,观察组体温、血象复常时间及脓腔消失、住院时间均显著短于对照组,差异有统计学意义(P0.05);观察组并发症总发生率为5.88%,显著低于对照组的17.65%,观察组治疗总有效率为94.12%,显著高于对照组的79.41%,差异均有统计学意义(P0.05)。结论超声引导下经皮穿刺置管引流术应用于老年细菌性肝脓肿治疗,可使患者临床症状、体征获得更快恢复,总疗效更理想,且术后并发症较少,有助于缩短患者住院时间。     

超声引导下置管引流术治疗细菌性肝脓肿33例的疗效观察

探讨超声引导下置管引流术治疗细菌性肝脓肿的效果及安全性。选取细菌性肝脓肿患者66例,按随机数字表法分对照组和研究组组各33例。对照组采取经腹切开引流术,研究组采取超声引导下置管引流术。对比两组围术期指标(手术时间、住院时间、白细胞计数恢复正常时间、体温恢复正常时间)、临床疗效、并发症(切口感染、弥漫性腹膜炎、胆瘘)发生率。研究组手术时间、住院时间、白细胞计数恢复正常时间、体温恢复正常时间较对照组少(P0.05);研究组总有效率(93.94%)与对照组(87.88%)相比无明显差异(P0.05);研究组并发症发生率(6.06%)较对照组(24.24%)低(P0.05)。采取超声引导下置管引流术治疗细菌性肝脓肿效果显著,且可缩短手术时间及住院时间,促使临床体征及症状改善,且术后并发症较少,具有安全性。     

Ultrasonically guided percutaneous drainage of abdominal fluid collections: A long-term study of its therapeutic efficacy

Fifty patients underwent ultrasonically guided percutaneous drainage (US-GPD) either with needle aspiration or catheter drainage. The procedures resulted in 70% complete recovery, 20% partial success and 10% of failures. The same patients were followed with clinical examination and sonography for a mean time of 36.3 months (minimum follow-up: 12 months). During the follow up period, 10 relapses occurred and one patient, considered for surgery after partial percutaneous treatment of a pyogenic liver abscess, recovered completely under conservative treatment. An analysis of the factors potentially related to the recurrence was made. It was found that one-step needle aspiration of abdominal abscesses and percutaneous treatment of chronic pancreatic pseudocysts are more prone to relapses. We conclude that US-GPD is an efficacious therapy for abdominal fluid collections, but an adequate drainage technique and a careful selection of the patients is crucial to avoid the possibility of relapse.     

Percutaneous management of breast abscesses. An experience of 39 cases

This is a review of our experience with percutaneous drainage by means of needle aspiration or catheter drainage of breast abscesses under ultrasound (US) guidance, and a suggested management algorithm. A retrospective study of the 39 patients (36 women, 3 men; mean age: 28.9 years) with breast abscesses who were treated by percutaneous US-guided procedures over a period of 13 years (1989 to 2002) was carried out. Of the 36 women, 34 were nonlactating and two lactating. Needle aspiration was used in the cases of fluid collections < or = 3 cm and catheter drainage in fluid collections of > 3 cm. Postdrainage care and US evolutive controls were carried out on an outpatient basis. Fine-needle aspiration cytology was performed in masses unresolved after postdrainage. Mammography was performed in patients over 30 years old. In all cases, US examination revealed images of fluid collection. A single needle aspiration was sufficient in 19 cases; 3 patients needed a second aspiration to resolve the breast abscess. A total of 15 cases were resolved by means of percutaneous catheter drainage. In 2 of the 17 patients who underwent catheter drainage, the mass persisted postdrainage; histologic findings showed a chronic abscess requiring surgical intervention in one and a breast carcinoma in the second. Mean follow-up was 8.4 months. Recurrence of breast abscess occurred in 4 patients, and these were resolved by surgical excision. Percutaneous drainage procedures in breast abscesses are a safe and effective alternative to incision and drainage. Needle aspiration is employed in cases of small abscesses and catheter drainage in abscesses larger than 3 cm. Although, in chronic abscesses, the treatment of choice is surgical excision, percutaneous drainage remains as an intermediate therapeutic option.     

Nonsurgical management of thyroid abscess with sonographically guided fine needle aspiration

Treatment of thyroid abscess commonly includes the surgical drainage along with systemic antibiotic therapy. Alternatives for open surgical intervention may be the conservative management with use needle aspiration or catheter drainage. We report here two cases of thyroid abscess treatment with 21-gauge needle aspiration under ultrasound guidance. In each case needle drainage was performed twice, at the 1st and 5th day of admission. Antibiotics were administered in pills and injected into the abscess cavity followed the pus aspiration and lavage. Both patients were cured. Follow-up has not revealed recurrence during 6 month and 5 years.     

EMS标准通道经皮肾镜治疗肾皮质脓肿17例临床分析

目的探讨EMS标准通道经皮肾镜治疗肾皮质脓肿的疗效及安全性。方法 17例肾皮质脓肿患者,均行EMS标准通道经皮肾镜穿刺、抽吸、置管引流治疗。结果本组均一次置管成功,治愈率100%;手术时间18~30min;金黄色葡萄球菌感染14例,大肠杆菌感染3例;术后留置引流管5~7d;无出血、尿瘘及肝、脾、肠管损伤等严重并发症发生;随访3~48个月无复发。结论 EMS标准通道经皮肾镜治疗肾皮质脓肿安全、有效。     

Percutaneous paracoccygeal catheter drainage of deep pelvic abscesses using a combination of sonographic and fluoroscopic guidance

Background  The purpose of this study is to demonstrate the feasibility, safety, and success of percutaneous paracoccygeal catheter drainage of deep pelvic abscesses using a combination of sonography and fluoroscopic guidance. Methods  From April 2005 to December 2006, under sonography and fluoroscopic guidance, sixteen patients with deep pelvic abscess underwent percutaneous paracoccygeal drainage. The causes of pelvic abscesses were post-operative complications. The patient was in prone position; the puncture site was first evaluated with sonography. After local anesthesia, a thin needle (22 G) was positioned along the lateral margin of the coccyx to avoid an eventual injury of sciatic nerve or vessels into the deep pelvic abscess under sonography guidance. Small dose of contrast was injected under fluoroscopy to verify the needle. With Seldinger technique catheters were placed for drainage. Catheter drainage was maintained for 9–40 days. Patients underwent clinical follow-up and subsequent imaging as necessary. Results  Neither significant complications nor technical failures were observed. A complete resolution of the abscess was achieved in 14 patients, and significant resolution of abscess was also observed in the other 2 patients. Conclusions  Sonography and fluoroscopic guided percutaneous paracoccygeal drainage is safe, feasible and efficient approach in the treatment of deep pelvic abscess.     

Percutaneous drainage of pelvic abscesses: management of the tubo-ovarian abscess

Percutaneous drainage of 35 pelvic abscesses secondary to pelvic inflammatory salpingitis are reported. Two methods of drainage were used: simple aspiration and catheter drainage. The success rate of aspiration drainage was 94 per cent, while catheter drainage yielded a 77 per cent success rate. The differences between pelvic abscess drainage and other types of percutaneous drainage are presented. The role of percutaneous drainage in the treatment of pelvic inflammatory disease is also discussed.     

超声引导下经皮穿刺置管引流术对细菌性肝脓肿患者氧化应激指标及影像学特征的影响

  目的  探讨超声引导下经皮穿刺置管引流术对细菌性肝脓肿患者氧化应激指标及影像学特征的影响。  方法  选取2018年10月~2021年7月于我院收治的细菌性肝脓肿患者70例，采用随机数字表法将患者分为对照组和观察组，35例/组。对照组行传统开腹脓肿切开引流术，观察组行超声引导下经皮穿刺置管引流术。比较观察组术前术后影像学表现，对比两组临床治疗效果，两组治疗前后氧化应激指标（丙二醛、超氧化物歧化酶、血清皮质醇）水平和并发症发生情况。  结果  观察组治疗总有效率高于对照组（97.14% vs 77.14%，P < 0.05）；影像学结果显示，术前肝区均可见混杂回声区且内部可见液性暗区，术中可见超声引导下穿刺针进入肝脓肿混杂回声区内，术后即刻可见液性暗区消失。观察组手术时间、引流时间、体温恢复时间、住院时间及白细胞数恢复正常时间均短于对照组（P < 0.05）；治疗前，两组超氧化物歧化酶、丙二醛、皮质醇水平差异无统计学意义（P>0.05）；治疗后，两组超氧化物歧化酶水平均升高，且观察组高于对照组（P < 0.05），两组丙二醛、皮质醇水平均下降，且观察组低于对照组（P < 0.05）；观察组术后胆瘘、脓气胸、伤口感染、肝内脓腔大出血及弥漫性腹膜炎等并发症总发生率明显低于对照组（20.00% vs 2.86%，P < 0.05）。  结论  细菌性肝脓肿患者经超声引导下经皮穿刺置管引流术治疗，疗效显著，且可有效改善血清氧化应激指标水平，且并发症发生率低。      

Hepatic abscesses in immunocompromised patients: Ultrasonically guided percutaneous drainage

Ultrasonically guided percutaneous drainage (US-PD) is considered first-line therapy for hepatic abscesses, but no data are available on its efficacy in severely immunocompromised patients. Therefore, we examined 15 such patients in whom one or more hepatic abcesses of different etiology were treated with US-PD. Eleven patients underwent needle aspiration and four had catheter drainage under US guidance. In 12 cases we achieved complete healing of the abscesses. In one case, clinical improvement was obtained but surgery was required for cure. In another case (fungal abscess in AIDS), we had no improvement and the patient died. No procedural complications were observed. Seven patients died during the follow-up periods of up to 49 months from their underlying disease. We conclude that US-PD must be considered the therapy of choice for hepatic abscess (except the fungal lesions) in severely immunocompromised patients.