超声引导下经皮穿刺引流治疗肝脓肿的效果观察

目的从实验室指标及脓肿大小等方面探究肝脓肿治疗中超声引导下经皮穿刺引流术的临床价值。方法选取苏北人民医院消化内科2013年1月-2018年8月行超声引导下经皮穿刺引流治疗肝脓肿的患者79例,排除病例丢失、中途转院或放弃治疗、年龄<18岁、未门诊随访的36例患者,最终入选43例行回顾性研究。计量资料组间比较采用t检验,计数资料组间比较采用χ^2检验。结果 43例患者均一次性穿刺置管成功,畏寒发热患者36例,31例(86.1%)患者体温于术后3 d恢复正常,术前术后的WBC、中性粒细胞百分比、AST、ALT及ALP水平比较,差异均有统计学意义(t值分别为6.668、6.255、2.337、3.001、5.198,P值均<0.05);术后脓肿直径(31±28) mm,明显小于术前(74±31) mm,差异有统计学意义(t=18.517,P <0.05);平均住院时长为(19.84±9.37) d;其中痊愈数为19例,占44.2%,治疗有效数为24例,占55.8%。本组43例患者肝脓肿液培养有38例阳性,其中肺炎克雷伯杆菌感染25例,占65.8%,为最常见病原菌。结论超声引导下经皮穿刺置管引流治疗肝脓肿穿刺成功率高、并发症少、临床疗效可靠,推荐为肝脓肿临床治疗首选。

Clinical effect of ultrasound-guided percutaneous drainage in treatment of liver abscess

Objective To investigate the clinical value of ultrasound-guided percutaneous drainage in the treatment of liver abscess from the aspects of laboratory markers and size of abscess.Methods A total of 79 patients with liver abscess who underwent ultrasound-guided percutaneous drainage in Department of Gastroenterology in Northern Jiangsu People’s Hospital from January 2013 to August 2018 were enrolled,among whom 36 patients who were lost or transferred,abandoned treatment,had an age pf < 18 years,or were not followed up in the outpatient service were excluded.A total of 43 patients were finally included in the retrospective study.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results All 43 patients achieved a one-time success of puncture and placement of drainage tube.Of all 43 patients,36 had fear of cold and pyrexia,among whom 31(86.1%) had a normal body temperature on day 3 after surgery,and there were significant changes in leukocyte count,percentage of neutrophils,aspartate aminotransferase,alanine aminotransferase,and alkaline phosphatase after surgery(t = 6.668,6.255,2.337,3.001,and 5.198,all P < 0.05).There was a significant reduction in the diameter of abscess after surgery(74 ± 31 mm vs 31 ±28 mm,t = 18.517,P < 0.05).The average length of hospital stay was 19.84 ± 9.37 days.Of all 43 patients,19(44.2%) were cured and 24(55.8%) had response to treatment.Of all 43 patients,38 had positive results of liver abscess culture,among whom 25(65.8%)had Klebsiella pneumoniae infection,suggesting that Klebsiella pneumoniae was the most common pathogenic bacteria.Conclusion Ultrasound-guided percutaneous drainage has a high success rate,few complications,and reliable clinical efficacy in the treatment of liver abscess.Therefore,it is recommended as the first choice for the clinical treatment of liver abscess.