超声引导介入治疗细菌性肝脓肿疗效观察

目的观察超声引导介入治疗细菌性肝脓肿的效果。方法 22例细菌性肝脓肿患者,其中10例脓腔直径<5 cm者,采用超声引导经皮穿刺抽吸药物冲洗术;12例脓腔直径≥5 cm者,采用超声引导经皮穿刺置管引流术。结果本组均完全治愈,术后均无严重并发症。其中4周治愈16例,8周治愈18例,6个月治愈22例。10例脓腔直径<5cm者,一次性抽吸治愈6例,二次3例,三次1例。12例脓腔直径≥5 cm者,4周治愈10例,8周13例,6个月12例。结论超声引导介入治疗细菌性肝脓肿疗效较好,可根据脓肿大小选择介入治疗方法。     

超声定位穿刺置管引流治疗化脓性肝脓肿的临床研究

目的:探讨超声定位穿刺置管引流治疗化脓性肝脓肿(PLA)的临床疗效。方法:2019年12月至2020年12月唐山市中医医院收治的化脓性肝脓肿患者61例，按照治疗方法的不同分为两组：抽吸排脓组(29例，行超声定位穿刺抽吸治疗)、置管排脓组(32例，行超声定位经皮穿刺置管引流治疗)。比较治疗前后两组患者的实验室指标，比较致病菌培养结果、疗效结果以及手术相关指标。结果:置管排脓组患者的肝功能指标ALT、AST、Alb、ALP、CRP、WBC、NEUT%、TNF-α、IL-6、IL-8水平以及总有效率、手术时间、脓腔消失时间、体温恢复至正常时间、住院时间、术后并发症发生率均优于抽吸排脓组(均P<0.05),而致病菌培养结果与抽吸排脓组相比，差异无统计学意义(P>0.05)。结论:对于老年人、感染较重、合并严重内科疾病、不能耐受手术者以及脓腔直径为3～8 cm的PLA患者应用超声定位经皮穿刺置管引流进行治疗具有显著优势，建议作为首选治疗方法。     

超声造影技术在糖尿病合并肝脓肿介入治疗中的临床研究

目的研究超声造影技术在糖尿病合并肝脓肿介入治疗中的临床应用价值。方法选取2019年5月—2020年4月在该院接受治疗的100例糖尿病合并肝脓肿患者,所有患者均采取常规抗感染、控制血糖治疗,同时所有患者经术前超声检查后,均接受超声引导下经皮穿刺脓腔置管引流术治疗。于治疗前和治疗后检测所有患者的血糖值,对比治疗前后患者血糖值的变化情况,同时分析运用超声造影技术行介入治疗的总体效果。结果治疗后所有患者的血糖值较治疗前相比均明显降低,体现在患者治疗后的空腹血糖、餐后2 h血糖、糖化血红蛋白水平均显著低于治疗前,差异有统计学意义(P<0.05);所有患者均在一次性穿刺成功,对肝脓肿的治疗总有效率可达到95.0%,并发症发生率为3.0%。结论超声引导下经皮穿刺脓腔置管引流术治疗糖尿病合并肝脓肿可获得理想效果,在介入治疗过程中运用超声造影技术可对患者的肝脓肿情况进行准确评估,从而提高穿刺抽吸成功率,更好控制血糖波动,且并发症少,安全性较高。     

老年人糖尿病合并细菌性肝脓肿的超声介入治疗

目的 评价超声引导下穿刺抽脓及置管引流治疗老年人糖尿病合并细菌性肝脓肿的临床应用价值。方法 对46例老年糖尿病合并细菌性肝脓肿的患者进行经超声引导下脓汁抽吸、置管引流治疗。结果 46例患者穿刺抽脓及置管引流全部成功，治愈率93．5％（43／46），所有患者均未出现穿刺并发症。随后30、60、180d经门诊随访未见复发。结论 超声引导下介入治疗老年人糖尿病合并细菌性肝脓肿安全、有效，可以明显缩短疗程，可作为首选的治疗方法。     

超声引导下穿刺抽脓并置管引流肝脓肿的疗效观察

目的探讨超声引导下行穿刺抽脓并置管引流治疗肝脓肿的临床疗效。方法选择我院从2014年6月至2017年6月收治的肝脓肿患者50例,随机分为对照组和观察组。对照组22例,给予超声引导下经皮穿刺针单纯抽吸治疗,观察组28例,给予超声引导下行穿刺抽脓并置管引流进行治疗。比较两组患者的临床疗效,观察脓肿腔消失时间、住院治疗时间、一次性治愈率及疼痛减弱时间等。结果观察组总有效率为100%,明显高于对照组(总有效率为86.36%);观察组疼痛减弱时间、住院时间、体温恢复时间及脓肿消失时间均明显低于对照组;两组相比,均差异有统计学意义。结论超声引导下行穿刺抽脓并置管引流的创伤小、疗效显著、不良反应少,是临床上治疗肝脓肿的有效方法,值得推广。     

超声引导下介入治疗艾滋病合并肝脓肿的临床价值

目的探讨超声引导下介入治疗艾滋病合并肝脓肿的临床价值。方法回顾性分析2009年10月至2014年1月在本科室行超声引导下介入治疗的艾滋病合并肝脓肿患者17例(31个肝脓肿)的治疗情况。结果全部17例患者中,单发脓肿9例,多发脓肿8例,脓肿总数31个。穿刺抽吸16个脓肿,置管引流15个脓肿,成功率100%,引流时间6~30天。手术未出现医护人员职业暴露,患者未出现不良反应,全部患者均治愈。1例患者肝脓肿治愈3个月后出现肝内新发脓肿,再次经皮穿刺抽吸后治愈。结论超声引导下介入治疗AIDS合并肝脓肿是一种安全、有效的治疗方式,亦是首选治疗方式。     

套管法肝插管引流抽脓术治疗肝脓肿31例的初步体会

1974～1979年我科应用套管针(膀胱穿刺针)肝插管引流抽脓术配合抗感染和支持疗法共治疗肝脓肿31例,现报道如下。本组病例均有肝脓肿症状且经肝穿刺抽出脓液证实。治疗方法本组病例均在一般抗感染及支持疗法基础上,用套管针行肝插管引流及反复抽脓加冲洗疗法。一、肝插管引流抽脓术1.适应证:较大型的肝脓肿需反复行肝穿刺抽脓     

经皮肝穿刺置管引流冲洗治疗肝脓肿

手术引流是治疗肝脓肿的传统方法之一,但其并发症和死亡率高达10—47％。我院五年来采取经皮肝穿刺置管引流、冲洗治疗肝脓肿37例,治愈率达100％。介绍如下: 资料和方法细菌性30例,阿米巴性5例,混合性2例。脓肿位于肝右叶28例,肝左叶6例,全肝3例。单脓腔29例,多脓腔8例。脓腔最大直径16cm,最小4.5cm。放置单管引流33例,双管引流4例。排脓量最多者达4800ml。合并隔下脓肿或右侧脓胸5例。方法;术前测定凝血机能,B型超声定位后,选择脓肿距体表最近的部位作穿刺点,常规皮肤消毒和铺孔巾,在局麻下先用细针试穿,抽出脓液后换用直径为5mm的穿刺套     

超声引导门静脉置管滴注抗生素联合穿刺抽洗治疗细菌性肝脓肿效果观察

目的：观察超声引导下门静脉置管滴注抗生素联合肝穿刺抽洗治疗细菌性肝脓肿的效果。方法选择细菌性肝脓肿患者140例,随机分为观察组62例、对照组78例。对照组采用常规静脉滴注抗生素联合肝穿刺抽洗治疗,观察组采用超声引导下门静脉置管滴注抗生素联合肝穿刺抽洗治疗。比较两组临床疗效、治疗结果及术后并发症。结果观察组总有效率为100％,对照组为71．79％,两组比较,P＜0．05。对照组临床见效时间、脓腔缩小50％时间及住院时间均长于观察组（P均＜0．05）。两组治疗期间及随访2个月均未出现严重并发症。结论超声引导下门静脉置管滴注抗生素联合肝穿刺抽洗治疗细菌性肝脓肿见效快,效果好。     

深静脉导管穿刺引流治疗细菌性肝脓肿的临床分析

目的探讨B超定位下应用深静脉导管穿刺引流治疗细菌性肝脓肿的临床疗效。方法选取我院2000—2007年收治的细菌性肝脓肿患者30例,治疗组17例应用深静脉导管行脓腔内置管冲洗引流,对照组13例应用深静脉穿刺针行脓肿穿刺抽吸治疗。比较两组患者的住院时间、住院费用及治疗效果等。结果治疗组在住院时间、住院费用及治疗效果等方面与对照组比较,差异有统计学意义(P<0.05)。结论B超定位下应用深静脉导管行肝脓肿穿刺引流结合术后脓腔冲洗,是临床治疗细菌性肝脓肿的一种较好方法。     

细菌性肝脓肿58例

目的:总结分析细菌性肝脓肿的临床特征及相关实验室检查结果,为该病的诊断和合理治疗提供依据.方法:总结我院2000-06/2011-12的58例确诊细菌性肝脓肿患者的临床资料,回顾性分析该病的临床特征、实验室检查、影像学、病原学及治疗特点.结果:58例细菌性肝脓肿患者最常见的临床表现为畏寒发热(94.8%)及右上腹痛(58.6%).糖尿病(46.5%)为最常见的合并症.血清碱性磷酸酶(77.6%)、白细胞(70.7%)和纤维蛋白原(60%)升高最常见.最常见的细菌为肺炎克雷伯菌(17.2%).脓肿多为单个(86.2%),肝右叶居多(81.1%).所有患者均选用联合抗生素治疗,其中26例患者(44.8%)行穿刺抽脓或置管引流,3例患者(5.2%)行手术治疗,1例患者(1.7%)死亡.结论:患者临床表现为畏寒发热、右上腹痛时应高度警惕细菌性肝脓肿可能,尤其是糖尿病、胆管疾病及恶性肿瘤患者.病原学仅在部分患者出现阳性结果,而血清碱性磷酸酶、白细胞和纤维蛋白原升高更常见,可能对临床诊断具有提示意义.抗感染结合穿刺抽脓或置管引流是临床安全有效的治疗手段.     

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.     

Hepatectomy for pyogenic liver abscess

BackgroundCommensurate with the advances in diagnostic and therapeutic radiology in the past two decades, percutaneous needle aspiration and catheter drainage have replaced open operation as the first choice of treatment for both single and multiple pyogenic liver abscesses. There has been little written on the place of surgical resection in the treatment of pyogenic liver abscess due to underlying hepatobiliary pathology or after failure of non-operative management.MethodsThe medical records of patients who underwent resection for pyogenic liver abscess over a 15-year period were retrospectively reviewed. The demographics, time from onset of symptoms to medical treatment and operation, site of abscess, organisms cultured, aetiology, reason for operation, type of resection and outcome were analysed. There were 49 patients in whom the abscesses were either single (19), single but multiloculated (11) or multiple (19). The median time from onset of symptoms to medical treatment was 21 days and from treatment to operation was 12 days. The indications for operation were underlying hepatobiliary pathology in 20% and failed non-operative treatment in 76%. Two patients presented with peritonitis from a ruptured abscess.ResultsThe resections performed were anatomic (44) and non-anatomic (5). No patient suffered a recurrent abscess or required surgical or radiological intervention for any abdominal collection. Antibiotics were ceased within 5 days of operation in all but one patient. The median postoperative stay was 10 days. There were two deaths (4%), both following rupture of the abscess.DiscussionExcept for an initial presentation with intraperitoneal rupture and, possibly, cases of hepatobiliary pathology causing multiple abscesses above an obstructed duct system that cannot be negotiated non-operatively, primary surgical treatment of pyogenic liver abscess is not indicated. Non-operative management with antibiotics and percutaneous aspiration/drainage will be successful in most patients. If non-operative treatment fails, different physical characteristics of the abscesses are likely to be present and partial hepatectomy of the involved portion of liver is good treatment when performed by an experienced surgeon.     

A comparison of amebic and pyogenic abscess of the liver

We evaluated the clinical features of 96 cases of amebic liver abscess and 48 of pyogenic hepatic abscess. Most patients with amebic abscess were young Hispanic males. Those with pyogenic abscess were older, without any ethnic predominance. Symptoms tended to be acute and localized to the right upper quadrant in amebic infection. In pyogenic disease, symptoms were often nonspecific and chronic in nature. A marked shift to the left of the leukocyte count occurred more frequently in pyogenic abscess, as did markedly abnormal values of the serum albumin, direct bilirubin, lactic dehydrogenase and aspartate aminotransferase. Sonography detected all cases of amebic abscess and missed the lesions in 2 of 39 patients with pyogenic abscess. Abscess cultures yielded pathogens in 90% of cases of pyogenic disease, while blood cultures were positive in 50%. Five of 20 patients with positive blood cultures had additional organisms isolated from the abscess that would have required adjustment of antibiotics for optimal coverage. We believe that all pyogenic abscesses should be aspirated to guide antibiotic therapy. In amebic abscess, the diagnosis was usually based on clinical and sonographic findings, aspiration being performed in only 14% of cases. Ninety-eight percent of patients were treated with amebicidal agents alone, and all responded to therapy. Therapeutic needle aspiration is rarely necessary. In pyogenic abscess, prolonged fever was common during medical therapy. Even in those eventually cured without surgery, the median time to defervescence was 8 days. Though 19 patients underwent surgical drainage, only 2 clearly did not benefit from medical treatment, having high fevers after more than 2 weeks on a regimen of appropriate antibiotics. Surgery is often performed prematurely because physicians expect fever to resolve quickly, but persistent fever of less than 2 weeks' duration should not constitute an indication for surgical drainage. Seven patients with pyogenic abscess died, 5 as a result of hepatic abscess. In 3 of these cases, the diagnosis was unsuspected till autopsy. Improved awareness of this disease may decrease morbidity and mortality from this treatable condition.     

Pyogenic liver abscess in the elderly

Seventeen patients over the age of 60 years, admitted to the Aberdeen Teaching Hospitals between 1980 and mid-1988, were diagnosed as having pyogenic liver abscess. Eleven were women and the mean age was 73.5 years. The diagnosis of liver abscess was made by needle aspiration in seven patients and was an unexpected finding at laparotomy in three. Six patients were thought to be suffering from advanced malignant disease until autopsy. The overall fatality was 53%. Misleading results from special investigations reduced the chance of a correct diagnosis in several patients. Even in frail elderly patients, a filling defect in the liver should not be attributed to metastatic malignancy when there is no known primary site, until liver abscess has been excluded by aspiration biopsy under ultrasound or computerized tomographic scan guidance. The high fatality of pyogenic liver abscess seems to be at least in part due to a lack of clinical suspicion.     

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 and surgical treatment of pyogenic liver abscesses: Observation over a 21-year period in 148 patients

BACKGROUND: Percutaneous drainage of pyogenic liver abscess has become first-line treatment. In the past surgical drainage was preferred in some centres. AIM: The aim of this retrospective study was to assess the effectiveness of percutaneous treatments and surgical drainage, in terms of treatment success, hospital stay and costs. PATIENTS: Data of 148 patients (90 males; 58 females; mean age, 61 yrs; range, 30-86 yrs) were retrospectively analysed. METHODS: Patients' outcomes, including the length of hospital stay, procedure-related complications, treatment failure and death, were recorded. Multiple logistic regression model was used for statistical analysis. RESULTS: One hundred and four patients (83 with solitary and 21 with multiple abscesses) were treated percutaneously, either by needle aspiration (91 patients) or catheter drainage (13 patients) depending on the abscess's size, and 44 patients (30 with solitary and 14 with multiple abscesses) were treated surgically. There was no statistically significant difference in patients' demographics or abscess characteristics between groups. Hospital stay was longer, and costs were higher in patients treated surgically (p<0.001). There was statistically significant difference in morbidity rate between groups (p<0.001). No death occurred in both groups. CONCLUSIONS: Percutaneous and surgical treatment of pyogenic liver abscesses are both effective, nevertheless percutaneous drainage carries lower morbidity and is cheaper.     

Predictive factors for early aspiration in liver abscess

AIM： To determine the predictive factors for early aspiration in liver abscess. METHODS： A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 （68%） patients, pyogenic in 200 （21%）, indeterminate in 73 （8%） and mixed in 32 （3%）. Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS： A total of 966 patients, 738 （76%） male, mean age 43 ± 17 years, were evaluated： 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were： age≥ 55 years, size of abscess ≥5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION： Patients with advanced age, abscess size 〉 5 cm, both lobes of the liver involvement and duration of symptoms 〉 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.     

Amebic liver abscess

We report eight cases of amebic liver abscess. All patients were men, and four were homosexual. Five of the eight patients had syphilis, but the four homosexual patients who were tested for HIV infection were negative. Ultrasonography (US), with or without needle aspiration, is the best method for diagnosing amebic liver abscess, and the treatment of choice is US-guided needle aspiration of the abscess followed by metronidazole therapy. Complication by other sexually transmitted diseases is another important factor affecting the treatment of this disease.     

Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases

Distinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ. We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies. Presumptive diagnoses of amoebic (n = 471; 82%) vs. pyogenic (n = 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy. Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P = 0.012). Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04). Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection. Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess. In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration.