细菌性肝脓肿的放射介入和双介入治疗

目的: 探讨放射介入和双介入治疗细菌性肝脓肿的临床疗效. 方法: 回顾分析51例细菌性肝脓肿病人(其中12例行放射介入或双介入治疗)的临床资料. 结果: 介入组12例病人无1例需中转手术引流,均痊愈出院;对照组39例中,有2例因脓肿导管引流不畅需行手术引流,39例中死亡3例,均死于多脏器功能衰竭,病死率为7.7%(3/39),两组差异无显著性(P>0.05);两组病人的退热时间差异无显著性(P>0.05),但介入组脓肿消退时间显著短于对照组(P<0.01). 结论: 放射介入治疗联合经皮肝脓肿穿刺引流,即双介入治疗细菌性肝脓肿具有良好的疗效.     

糖尿病合并细菌性肝脓肿患者介入治疗的护理

对10例糖尿病合并细菌性肝脓肿患者在CT导向下经皮肝穿刺行介入治疗,术前精心准备．术中做好体位护理和病情观察,术后进行并发症观察、及时对症护理,加强引流管护理,结果所有患者顺利完成治疗,康复出院。     

1例巨大阿米巴肝脓肿患者行介入治疗的护理

对1例巨大阿米巴肝脓肿老年患者先后2次在B超引导下行经皮肝穿引流术。结果患者治愈。提出术后每日通过引流管行抗生素冲洗，密切观察体温、腹部症状变化．配合心理护理和饮食指导是治愈患者的重要保证。     

B超普通探头引导经皮肝穿刺抽脓治疗细菌性肝脓肿

１９８９年１０月至１９９７年６月我院采用超声普通探头引导下抽吸浓液后注射药物治疗肝脓肿７３例，共９６个病灶，其中单发性脓肿５８例，多发性脓肿１５例，脓肿最大直径１１．６ｃｍ，每次抽脓量最多为２００ｍｌ，治疗次数１￣４次不等。治疗结果：７２例治愈，１例死亡，共行穿刺１３２次，未发生严重并发症。本法具有适应证广，创伤小，副作用少，疗效好，患者经济负担小，易于接受等特点。     

肝段切除治疗细菌性肝脓肿体会

肝段切除治疗细菌性肝脓肿体会刘宏方我院自１９８７年２月～１９９６年４月共收治细菌性肝脓肿６２例，采用一次性肝段切除术治疗肝脓肿１０例，疗效满意，治疗体会报告如下。１临床资料１１一般资料本组１０例，男６例，女４例。年龄１６～５２岁。均有畏寒、发热、肝...     

细菌性肝脓肿53例外科治疗临床探讨

细菌性肝脓肿５３例外科治疗临床探讨柳州市第一人民医院（５４５００１）黄平朱其一我院１９８９～１９９７年共收治细菌性肝脓肿５３例，采用了经皮引流、手术引流及病灶切除等方法治疗，取得满意的效果，现总结报告如下。１临床资料本组５３例，男３９例，女１４例。年...     

1例巨大阿米巴肝脓肿患者行介入治疗的护理

对1例巨大阿米巴肝脓肿老年患者先后2次在B超引导下行经皮肝穿引流术。结果患者治愈。提出术后每日通过引流管行抗生素冲洗,密切观察体温、腹部症状变化,配合心理护理和饮食指导是治愈患者的重要保证。     

细菌性肝脓肿的诊断与治疗

目的 总结细菌性肝脓肿的诊治经验。方法 对５２例细菌性肝脓肿进行回顾性分析。结果 （地）胆总管梗阻和化脓性胆管炎是本病的主要病因。（２）寒战、高热、肝区疼痛及白细胞增高是本病的主要临床表现。（３）早期诊断,充分引流是治愈的关键。结论（１）细菌性肝脓肿是常见病。（２）辅助检查首选Ｂ超。（３）剖腹探查,经腹腔引流是本病首选引流入路。     

多孔针灌洗治疗细菌性肝脓肿

我院自1989年1月至1997年8月对13例肝脓肿患儿采用多孔针穿刺抽脓、冲洗、注入抗生素治疗,全部治愈,未出现并发症,报告如下。临床资料1　一般资料:本组男8例,女5例,年龄2～14岁,平均6岁。脓肿15个,右叶11个,左叶4个。B超测定脓腔直径最小3.1cm、最大9.8cm。首次抽脓最少6ml,最多75ml,平均26ml。脓液细菌培养10例,1例为金黄色葡萄球菌,1例为大肠杆菌,余8例无细菌生长。均有或曾有发热、肝区痛,11例有白细胞及白细胞比值升高。发病至首次抽脓时间最短6天,最长45天。抽脓前均用抗生素治疗。2　多孔针的构造:在普通穿刺针头的前部8mm以内的前后…     

中西医结合治疗细菌性肝脓肿

中西医结合治疗细菌性肝脓肿江苏省邳州市人民医院普外科（江苏２２１３００）卢庆凯，刘圣亚，康尔强作者普外科１９９２年１２月－１９９４年１１月，采用中西压结合治疗细菌性肝脓肿１２例，现报告如下：１临床资料本组１２例．男５例。女７例，年龄最小１１岁，最大６...     

Results of treatment of pyogenic liver abscesses

In the last 7 years 53 patients with liver abscesses were treated at surgical clinic of Charité. Since November 1982 we treated in 27 cases with solitary and multiloculary liver abscesses by percutaneous drainage of the abscess diameter more than 3 to 4 cm. 12 patients with multiloculary small biliary liver abscesses were treated by antibiotics. The bacteriological examination were performed after CT-supported puncture of the abscess. Seven patients with complicated abscesses could not be healed with CT-drainage. Surgical drainage via laparotomy was necessary. The diagnostic clarification of the dignity is important in every case. The lethality of all treated liver abscesses was 5.6% and the causes of death were the existing basic diseases.     

细菌性肝脓肿经皮穿刺与手术治疗疗效的比较

目的：比较细菌性肝脓肿经皮穿刺与手术治疗的疗效。方法：回顾分析首都医科大学宣武医院1989年1月—2008年12月收治的193例细菌性肝脓肿患者的临床资料,按治疗方法分为经皮穿刺组（96例）及手术治疗组（97例）,比较2组的治疗成功率、并发症率、死亡率及住院时间。结果：2组患者的性别,年龄,糖尿病有无,白蛋白水平,脓肿的部位、个数、大小、来源等差异均无统计学意义。经皮穿刺组患者治疗成功率、死亡率及平均住院时间分别为87.5%（84/96）、2.1%（2/96）、（20.8±12.4）d;手术组为94.8%（92/97）、2.1%（2/97）、（18.9±13.5）d,差异均无统计学意义（P=0.072,1.000,0.575）。经皮穿刺组并发症率较手术组低（2.1%vs9.3%,P=0.037）。结论：经皮穿刺治疗细菌性肝脓肿与手术同样有效,且并发症率较低,应成为肝脓肿治疗的首选。     

The diagnosis and treatment of pyogenic liver abscesses.

Pyogenic liver abscesses in 106 adult patients at The New York Hospital were reviewed to define optimum treatment. Mortality in the surgically treated patients was 26% (17/65), while those treated nonsurgically had a fatality rate of 95% (39/41). Multiple abscesses treated surgically had a surprisingly low mortality of 29% (5/17). Modern noninvasive tests are highly sensitive in diagnosing liver lesions greater than 2 cm. Difficulty remains in identifying small hepatic abscesses and differentiating large abscesses from tumor. Most liver abscesses have an identifiable source outside the liver. The most common source (31%) was cholangitis secondary to extrahepatic biliary obstruction. Multiple abscesses, mixed organisms, hyperbilirubinemia, and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor determining survival. Most patients who have the underlying pathogenesis of the abscess controlled will survive surgical treatment. Transperitoneal surgical drainage and antibiotics remain the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.     

Percutaneous drainage of pyogenic liver abscesses

Twenty-one patients with liver abscesses were treated by percutaneous drainage over a 2 1/2-year period. Percutaneous drainage was successful in 18 (85%) of 21 patients. Complications include 2 inadvertently dislodged catheters, 1 septicemia and 1 pleural effusion. There were 2 deaths. The low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggest that this therapy should be tried before operative intervention is considered.

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Resumen Veintiun pacientes con abscesos del hígado fueron tratados mediante drenaje percutáneo en un período de 2 1/2 años; el drenaje fue exitoso en 18 (85) de 21 pacientes. Las complicaciones incluyeron 2 catéteres desalojados en forma accidentai, 1 septicemia, 1 derrame pleural. Se presentaron 2 muertes. La baja morbilidad y la elevada tasa de éxito en el tratemiento de los abscesos hepáticos por drenaje percutáneo hace pensar que esta modalidad terapéutica debe ser ensayada antes de considerar intervención operatoria.

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Résumé Nous avons traité par drainage percutané 21 patients ayant un abcès du foie en deux ans et demi. Le drainage percutané était un succès chez 18 (85) des 21 patients. Les complications comprenaient 2 cathéters arrachés par mégarde, une septicémie et un épanchement pleural. Il y eu 2 décès. Le taux de morbidité peu élevé et le taux de réussite important dans le traitement des abcès du foie par drainage percutané incite à essayer cette thérapie avant d'envisager à une intervention chirurgicale.

     

Percutaneous management of pyogenic liver abscesses

Twenty-four pyogenic liver abscesses have been treated during a six-year period percutaneously. Percutaneous management included percutaneous drainage and fine needle aspiration under ultrasound or CT scan guidance. Percutaneous management was successful in 92% of cases, and no further treatment was required in 91% of these. One patient died, giving a mortality rate of 4.1%. There were no complications related to this method. The authors conclude that percutaneous management of pyogenic liver abscesses should be attempted in all cases, since results compare favourably with surgical procedures.     

Intrahepatic pyogenic abscesses: treatment by percutaneous drainage

During a 6 year period, 18 liver abscesses in 12 patients were identified by computerized tomography. Five patients had presumed hematogenous seeding. Five patients previously had bilioenteric anastomoses, stents, or both to relieve obstructive jaundice. Four patients with abscesses had recent abdominal operations. Diagnosis was established by guided needle aspiration and treatment was provided by percutaneous catheter drainage. Organism-specific antibiotics were administered to all patients. Patients were evaluated for recurrence by serial computerized tomographic studies and were clinically followed up for a minimum of 15 months. Ten of 12 patients (83 percent) and 16 of 18 abscesses (89 percent) were successfully treated by percutaneous catheter drainage. Two failures required operative intervention. In summary, the low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggests that this therapy be tried before operative intervention is considered.     

Multiple pyogenic brain abscesses

Summary Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants.The clinical presentation was similar to brain abscess in general. 21 patients had altered sensorium at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%).The abscesses were invariably large in size.The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients.Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule.The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome.Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.     

Intrahepatic abscesses: amebic and pyogenic

Of forty patients studied with intrahepatic abscesses between 1951 and 1971, twenty-one had amebic and nineteen had pyogenic abscesses. Amebic abscess is treated by parenteral use of emetine and aspiration of the abscess. Open drainage is undesirable in an uncomplicated case of amebic abscess. Pyogenic abscess is treated by adequate drainage of the purulent material without contamination of the peritoneal and pleural cavities.