超声引导下穿刺置管引流加无水乙醇注射治疗单纯性肾囊肿

目的　探讨彩超引导下穿刺置管引流加无水乙醇注射治疗单纯性肾囊肿的疗效。方法　在彩超引导下 ,对 60例直径在 5～ 15cm的单纯性肾囊肿穿刺置管引流 ,并且间断注射无水乙醇 1～ 3次 ,彩超复查囊肿大小变化。结果　穿刺治疗后 1,3 ,6个月复查彩超 ,治愈 49例(81.1% ) ,显效 8例 (13 .4% ) ,无效 3例 (5 .0 % )。结论　 (1)彩超引导下穿刺置管引流加无水乙醇注射是治疗单纯性肾囊肿的有效方法 ,操作简单、创伤小。 (2 )防止置管脱落是保证疗效的关键。     

超声引导穿刺联合多途径给药治疗乳腺单纯性囊肿的临床疗效研究

目的:探讨超声引导穿刺联合多途径给药治疗乳腺单纯性囊肿的临床疗效。方法:回顾性分析120例乳腺单纯性囊肿的临床及影像资料,其中70例行超声引导穿刺联合多途径给药治疗(联合治疗组);50例行单纯超声引导穿刺治疗(对照组)。联合治疗组采用超声引导下囊肿穿刺抽液注入无水乙醇冲洗后,再注入1/4~1倍囊液量的地塞米松和庆大霉素混合液保留,并口服中成药小金片3个月;对照组采用超声引导下穿刺抽液、注射无水乙醇硬化冲洗、再保留1/4囊液量的无水乙醇治疗。2组患者在术后3个月、6个月和12个月复查,比较2组囊肿消失程度、复发率等。结果:术后12个月联合治疗组有效率为100%,治愈率95.7%,无复发;对照组有效率90.0%,治愈率80.0%,复发率6.0%,2组差异有统计学意义(P0.05)。结论:超声引导穿刺联合多途径给药治疗乳腺单纯性囊肿疗效确切,操作简便、安全,临床治愈率高。     

CT导引下置猪尾导管硬化治疗巨大肝肾囊肿疗效观察

目的探讨CT导引下穿刺置猪尾引流管硬化巨大肝肾囊肿安全性及疗效。方法CT导引下对17例巨大肝肾囊肿患者,穿刺置入7F猪尾导管引流,并且每日注射无水乙醇或乙酸1次。对于囊液<500ml者,每次注入硬化剂后夹闭引流管,24h后再开放引流。囊液大于500ml者,硬化后立即开放引流。所有患者24h引流量<10ml时,再次硬化后拔除引流管。其中肝囊肿平均拔管时间40d;肾囊肿10d。结果本组硬化治疗后6个月,复查B超示治愈17例,治愈率100%。无一例出血、感染及出现心脑血管并发症。结论CT导引下置猪尾巴管硬化治疗巨大肝肾囊肿简单安全、疗效满意。     

用Arrow管引流分次无水乙醇硬化治疗老年巨大肝囊肿

随着非血管介入技术的不断发展和完善,经皮肝穿刺抽液无水乙醇硬化治疗肝囊肿已广泛应用于临床。在此期间,人们常用普通肝穿针（Chiba针）。也有用内带套管针的猪尾巴导管怛。进行穿刺引流和抽液,为了排出囊液更彻底、注入囊内的无水乙醇不被稀释,乙醇与囊壁接触更广泛,远期疗效更确切,我们选择了18例老年巨大肝囊肿患者,采用Arrow管（一种中心静脉留置管）置管引流,分次乙醇硬化治疗,将远期效果总结分析。     

CT导向下无水乙醇硬化治疗肝囊肿

目的评价在CT导向下经皮穿刺硬化治疗肝囊肿的临床价值。方法63例肝囊肿患者,其中41例单发,22例多发,均任CT导向下经皮穿刺注射无水乙醇行硬化治疗。结果63例患者随访3～15个月,疗效指数0级4例(6.3%),Ⅰ级8例(12.7%),Ⅱ级23例(36.5%),Ⅲ级28例(44.4%)。硬化治疗总有效率为93.6%。未出现严重的并发症。结论无水乙醇硬化治疗肝囊肿安全、经济、简单、有效。     

超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿

目的评价超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿的效果。方法46例单纯性肾囊肿患者(男性26例,女性20例,平均年龄65岁)均经超声引导经皮穿刺抽吸和注射无水乙醇硬化治疗。全部操作是在局部麻醉下完成的。治疗后,全部病人经超声或CT随访1至6个月。囊肿与治疗前比较,减小2/3以上为有效,完全消失为治愈。结果46个囊肿中,2个囊肿抽出液蛋白定性试验阴性,抽液后未注入无水乙醇,其余44个囊肿于治后1,3,6个月呈进行性缩小,6个月时复查有效率为100%,治愈率为90.6%。结论超声引导经皮穿刺抽吸和注射无水乙醇是治疗单纯性肾囊肿的一种操作简单、痛苦小、费用低、安全有效的方法,值得临床推广应用。     

CT导向下肾囊肿的穿刺硬化治疗

目的 评价CT导向下经皮穿刺无水乙醇注射治疗肾囊肿的临床应用价值。资料与方法 16例24个肾囊肿，其中单纯性肾囊肿10例，肾盂旁囊肿2例，多囊肾4例，在CT导向下行穿刺无水乙醇硬化治疗，分析其并发症，并追踪观察其疗效。结果 16例中，24个囊肿顺利完成穿刺硬化治疗，无严重并发症发生，对18个囊肿术后追踪观察3个月-1年，0-Ⅲ级囊肿疗效个数分别为1（5.6%)，2（11.1%),3(16.7%)和12（66.7%)，临床症状缓解率为81.8%(9/11)。结论 CT导向下经皮肾囊肿穿刺无水乙醇硬化治疗是一种安全有效的治疗方法。     

CT引导下经皮急性胰腺炎急性液体聚集穿刺置管引流术

目的 评估CT引导下经皮急性胰腺假囊肿穿刺置管引流术的效果和临床应用价值.方法 对23例患者进行了CT引导下经皮急性胰腺假囊肿穿刺置管引流术并与13例未进行置管引流的对照组病例进行比较.结果 23例中,3例因反复疏通引流管导致感染失败,治疗效果与对照组存在显著统计差异.结论 CT引导下经皮胰腺急性假性囊肿穿刺置管引流术,属微创性手术,病人痛苦小,安全,引流效果良好.     

超声引导下经皮穿刺抽吸或置管治疗细菌性肝脓肿疗效比较

目的 比较超声引导下穿刺抽吸或置管引流对细菌性肝脓肿的疗效。方法 回顾性分析我院1994-01至2013-01收治的经超声引导下穿刺抽吸或置管引流的细菌性肝脓肿96例,分别比较两组患者之间的治疗成功率、并发症率、病死率及住院时间。结果 分别有42例及54例行穿刺抽吸及置管引流治疗,两组间并发症率（4.8%vs 5.6%,P=1.00）、病死率（2.3%vs 1.9%,P=1.00）及住院时间[（19.1±12.1）d vs（21.6±12.5）d,P=0.44]差异无统计学意义。置管引流组治疗成功率显著高于抽吸组（61.9%vs 92.6%,P=0.00）,但对于脓腔直径≤6 cm者,治疗成功率无明显区别（91.0%vs 96.7%,P=0.57）。结论 超声引导下经皮穿刺置管引流治疗肝脓肿优于穿刺抽吸,对于直径≤6 cm者,穿刺抽吸是可选择的替代手段。     

经皮肝穿刺置管引流治疗肝脓肿5例

目的：了解经皮肝穿刺置管引流治疗肝脓肿的临床观察。方法：5例在影像引导下经皮肝穿刺置管引流治疗,本组5例,男3例,女2例;年龄46~68岁。均进行CT及临床确诊。结果：成功为5例患者在影像引导下经皮肝穿刺置管引流治疗肝脓肿,总有效率100%。结论：经皮肝穿刺置管引流治疗肝脓肿方法直接、安全、简便、有效,是目前治疗肝脓肿最有发展前景、值得推广的好方法。     

一次CT导引下置双针穿刺硬化治疗双肾多发肾囊肿的应用体会

目的 探讨一次CT导引下于左右两侧肾区分别置针进行穿刺抽吸、注射硬化剂治疗肾囊肿的应用价值.方法 在一次CT导引下分别于脊柱两侧肾区内确定穿刺点、设计穿刺路径,分别给予交替穿刺、抽吸、冲洗、保留乙醇等治疗步骤,对19例多发肾囊肿进行硬化治疗.结果 通过对19例两侧多发肾囊肿患者同时进行硬化治疗的时间统计,最短延长20 ...     

Single-session alcohol-retention sclerotherapy for simple renal cysts: comparison of 2- and 4-hr retention techniques

OBJECTIVE: The objectives of our study were to evaluate the feasibility of ethanol sclerotherapy in treating simple renal cysts with prolonged ethanol retention and to compare the therapeutic results of 2- and 4-hr retention techniques. MATERIALS AND METHODS: We retrospectively reviewed 36 renal cysts in 33 patients treated by ethanol sclerotherapy with a single-session single-injection technique during the past 6 years. After complete aspiration of the cystic fluid, 95% ethanol was injected into the cyst and was retained for 4 hr in 14 cysts (group 1) and for 2 hr in 22 cysts (group 2). The average maximal diameter and aspirated volume of the cysts were 8.3 cm and 223 mL in group 1 patients and 7.9 cm and 167 mL in group 2, respectively. The ablated cysts were followed up regularly by sonography, CT, or both at 3- to 6-month intervals for at least 1 year. The nonparametric Mann-Whitney U test was used to compare differences in characteristics, treatment results, and laboratory data of the subjects in the two groups. The level of statistical significance was set at a p value of less than 0.05. RESULTS: Technically, all the patients tolerated the procedures. One patient had gross hematuria 10 days after the procedure. She underwent surgical deroofing treatment and was excluded in the later statistical analysis. After sclerotherapy, 14 cysts disappeared completely and 16 cysts showed marked regression with residual maximal diameter of less than 3 cm. The overall volume reduction rate was 97.6% in all 35 cysts. The mean residual longest diameters and average volume reduction rates of the treated cysts were 1.9 cm and 97.9% in group 1 patients and 1.1 cm and 97.3% in group 2 patients, respectively, which showed no statistical significance of volume reduction rate with a p value 0.149. CONCLUSION: The single-session prolonged ethanol-retention technique is safe and efficacious for the treatment of renal cysts. There is no statistical difference in therapeutic efficacy between 2- and 4-hr ethanol-retention techniques.     

Percutaneous treatment of symptomatic non-parasitic benign liver cysts: Single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure

To evaluate whether prolonged catheter drainage with negative pressure yields better results than single-session alcohol sclerotherapy in the treatment of symptomatic non-parasitic benign liver cysts. Forty patients were randomly assigned to two groups in a 24-month prospective controlled trial. One group was treated with ultrasound-guided prolonged catheter drainage with negative pressure (20 patients with 24 cysts) and the other group with single-session alcohol sclerotherapy (20 patients with 23 cysts). Patient demographics, clinical characteristics, treatment outcome, and complications were analyzed. The median volumes and 95% CI (confidence interval) for the medians and interquartile ranges of all 47 cysts before treatment and on last follow-up were: 389 ml, 143–1,127 ml, 136–1,300 ml, and 0 ml, 0–10 ml, and 0–23 ml, respectively (P<0.0001). The average volume reduction was 92.4% (range, 74.9–100%), 94.2 % (range, 74.9–100%) in the drainage and 90.2% (range, 76.9–100%) in the sclerotherapy group. Twenty-seven cysts (57.4%) disappeared completely, 16 (66.7%) in the drainage and 11 (47.8%) in the sclerotherapy group. No differences in average volume reduction, final volume and disappearance of the cysts between the groups were noted. The hospital stay was 1 day for all patients. Percutaneous treatment is safe and effective for hepatic non-parasitic cysts. Prolonged catheter drainage with negative pressure and single-session alcohol sclerotherapy had similar results. An erratum to this article can be found at     

2种硬化剂在单纯性肝肾囊肿硬化治疗中的对比研究

目的:对超声引导下单纯性肝肾囊肿穿刺注射新型硬化剂和无水乙醇治疗的疗效进行对比研究。方法:对32例患者36个肝肾囊肿(18例肝囊肿,14例18个肾囊肿)经超声引导抽净囊液后,注入适量新型硬化剂1%聚桂醇注射液(国药准字H20080445),并留置囊内,观察治疗过程中发生的不良反应、患者耐受程度,6月跟踪统计有效率;并与我院采用传统无水乙醇硬化剂治疗的肝肾囊肿统计数据进行对比。结果:32例36个囊肿均一次穿刺成功,按1/10～1/4的比例注入新型硬化剂并保留囊内,患者耐受性良好,无刺激性疼痛和醉酒症状,治疗后1周内,9例患者诉侧腹轻微胀痛,间断低热2 d,未经特殊处理自行消失,无严重不良反应。6月复查33例全部消失,3个囊肿缩小2/3以上,有效率达100%,长期疗效仍在跟踪中。采用传统无水乙醇作为硬化剂注射治疗肝肾囊肿20例(12例肝囊肿,8例肾囊肿),抽净囊液后,按1/4～1/3比例注入无水乙醇,注射时均有短暂刺激性疼痛,18例出现面红、心跳加快、口干、恶心呕吐等醉酒症状。6月复查15例完全消失,5例缩小2/3以上。结论:新型硬化剂聚桂醇治疗肝。肾囊肿疗效与传统无水乙醇硬化治疗一致,但它留置体内,无刺激性剧痛,无醉酒症状,操作简单,不良反应少,患者耐受性好,优于无水乙醇,有望在肝肾囊肿的硬化治疗中成为无水乙醇的替代物。     

Percutaneous aspiration and ethanol sclerotherapy of symptomatic hepatic cysts

Nineteen patients with 49 symptomatic non-neoplastic non-parasitic simple hepatic cysts were subjected to ultrasonographically guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. Small cysts were treated twice, the large ones three times at the same sitting. The volume of alcohol per injection varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one ethanol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. Forty-seven of the 49 cysts could be treated adequately, and did not recur during a follow-up period af 12–40 months. The results indicate that aspiration an and ethanol sclerotherapy is the treatment of choice in patients with symptomatic non-neoplastic simple hepatic cysts or polycystic liver disease. Correspondence to: A. Leinonen     

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

Objective

The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts.

Materials and Methods

Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination.

Results

After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group.

Conclusion

Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.     

Percutaneous treatment of hydatid liver cysts in children as a primary treatment: long-term results

PURPOSE: To evaluate the effectiveness and long-term results of percutaneous treatment for hydatid liver cysts in pediatric patients. MATERIALS AND METHODS: Thirty-four pediatric patients (15 male, 19 female; ages 4-17 years; mean age, 9.4 years) with 51 hydatid liver cysts underwent ultrasound (US)-guided percutaneous treatment with albendazole prophylaxis. There were 15 type II lesions with membrane detachment and 36 type I lesions resembling simple hepatic cysts with pure anechogenic content or small echogenic reflections and a regular well-delineated wall. The method of US-guided puncture, aspiration, injection of hypertonic saline solution, and reaspiration was preferred for 21 lesions. For the remaining 30 larger cysts, the intervention was performed with the same percutaneous technique but followed by catheterization, drainage, control cystography, and sclerotherapy with ethanol. During follow-up, US examinations were performed at 1, 3, 6, and 12 months for the first year and yearly thereafter. RESULTS: Percutaneous treatment of hepatic hydatid disease was successful in 33 patients (97.1%). During follow-up, US findings in the lesions changed significantly; at year 1, the inner content of the lesions became heterogeneous with a semisolid appearance, and the mean reduction in volume was 81.4%. At 2-year follow-up, most hydatid cysts had become solid in nature and the reduction in volume reached 65%-99% (mean, 85.1%). There were no recurrences or additional lesions after the follow-up of 1-6 years (mean, 3.1 years). Average hospital stay for the whole group in this study was 3.5 days. CONCLUSIONS: The long-term results of percutaneous liver hydatid cyst treatment in children are in accordance with the results in adults. Percutaneous treatment of uncomplicated type I and type II liver hydatid cysts in pediatric patients is an efficient and safe treatment with short hospitalization.     

Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15–2900 mL). The mean catheterization duration was 11.8 days (1–60 days). The mean follow up time was 25.8 months (2–64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.     

Ultrasound-guided drainages and sclerotherapy

Ultrasonically guided fluid collection and abscess drainage have become routine procedures in various parts of the body. In most cases ultrasound is the only imaging and guidance modality needed; however, it is of the utmost importance to remember that CT and fluoroscopy with contrast often give invaluable information when the true extent of the process has to be determined and when assessing the safest route for the catheter in anatomically complicated areas. The importance of irrigation of the abscess cavity with fluids and the ready use of urokinase should be emphasized. Ethanol sclerotherapy is a simple and safe procedure to treat symptomatic hepatic or renal cysts. Parathyroid adenomas and cysts, as well as thyroid cysts, can also be treated with ethanol sclerotherapy in selected cases. Purified mineral talc has been used in pleurodesis and hydrocele sclerotherapy, whereas doxycycline or ethanol is used for postoperative lymphoceles. Both abscess drainages and sclerotherapy procedures are minimally invasive, simple, safe, inexpensive and reasonably efficacious treatment in many clinical instances and may be at least an alternative to surgical treatment, often offering significant advantages over surgery.