Complications after interventional sonography of focal liver lesions: a 22-year single-center experience.

OBJECTIVE: To analyze the complications of diagnostic and therapeutic sonographically guided interventional procedures of focal liver lesions observed during a 22-year period in a single center. METHODS: Complications of sonographically guided diagnostic and therapeutic procedures on focal liver lesions, observed during a 22-year period in a single center, were reviewed. From 1979 to 2001, 13,222 patients (age range, 7-89 years; mean, 59 years; 8,688 male and 4,534 female) with 13,777 focal liver lesions underwent 16,648 sonographically guided biopsies and 3,035 therapeutic procedures: pyogenic and amebic abscess aspiration, ethanol injection of hydatid liver cysts, and percutaneous ablative treatments (ethanol injection in either multiple or one-shot sessions, radio frequency ablation, and interstitial laser photocoagulation) of primary and secondary liver tumors. RESULTS: The overall mortality was 0.06%. No death or major complication occurred after diagnostic procedures and liver abscess drainage. In the therapeutic group mortality was 0.6%: 1 patient died of anaphylactic shock during treatment of a hydatid cyst; 7 patients died after liver tumor ablation with ethanol injection (6 after one-shot treatments and 1 after multisession treatments). Major complications after liver tumor ablative procedures included 10 cases of acute liver failure, 2 cases of acute tubular necrosis, 2 cases of self-limiting hemoperitoneum, 2 cases of paralytic ileum, 2 abscesses, and 1 case of cholangitis. One case of a biliary cyst fistula and 1 case of intracystic hemorrhage occurred after treatment of hydatid liver cysts. CONCLUSIONS: Sonographically guided diagnostic biopsy of focal liver lesions and liver abscess drainage are safe procedures. In contrast, liver tumor ablation procedures have a low but definite risk of mortality and major complications. Puncture of hydatid cysts must be performed only in institutions that can treat anaphylactic shock.     

Sonographically guided percutaneous treatment of hepatic hydatid cysts: long-term results

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic hydatid cysts. METHODS: Sixty-one patients with 84 hepatic hydatid cysts were treated using the puncture, aspiration, injection, and reaspiration (PAIR) technique under sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic saline solution (38 patients) or 0.5% silver nitrate (23 patients). All patients underwent follow-up examinations for 1 month-6 years after aspiration. Clinical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals. RESULTS: Serial sonographic examinations revealed a heterogeneous echo pattern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%); calcification of the cyst wall, cystic contents, or both in 10 cysts (12%); and complete disappearance of 1 cyst (1%) in a patient who had been monitored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration attempt. Two patients developed infection of the cyst cavity after PAIR-PD and were successfully treated with oral antibiotics. An anaphylactic reaction developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was observed in any patient over the follow-up period of 72 months (mean, 26 +/- 27 months). CONCLUSIONS: Percutaneous drainage of hydatid cysts is a safe, effective, and reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solutions, gave excellent results.     

超声引导下经皮肝穿内囊原位剥脱聚桂醇硬化治疗肝囊型包虫的应用价值

目的探讨超声引导下经皮肝穿内囊原位剥脱聚桂醇硬化治疗肝囊型包虫的应用价值。方法超声引导下对11例肝囊型包虫患者行经皮肝穿内囊抽吸囊液,后注入聚桂醇注射液,反复冲洗15 min抽出,见内囊局部塌陷与外囊之间形成间隙,再穿刺入内外囊间隙,边抽吸边缓慢注入高渗盐水,将内囊脉冲式原位剥脱,抽尽后注入聚桂醇注射液,反复冲洗15 min抽出。结果 1次穿刺成功率100%,治疗后1、6、12个月彩超复查11例肝囊型包虫体积均缩小,内部实变,部分囊肿出现钙化,有效率达100%。结论超声引导下经皮肝穿内囊原位剥脱硬化治疗肝囊型包虫疗效显著,患者耐受性好,是一种安全、有效、可靠的方法,做到了早发现早治疗。     

超声介入肝、肾、卵巢囊肿硬化治疗术的临床应用

目的 探讨超声介入对肝、肾、卵巢囊肿无水酒精硬化治疗的临床应用价值。方法对87例91个肝、肾、卵巢囊肿在高分辨率彩色多普勒超声引导下无水酒精硬化治疗。结果随访时间最长4年，最短9个月，除5例囊肿二次治疗，囊肿消失时间为一年以上，其余82例86个囊肿全部在一年内消失，未见复发，总有效率100％。结论超声介入无水酒精硬化治疗腹腔脏器肝、肾、卵巢囊肿准确性、恢复快、疗效显著、复发率低，应成为治疗肝、肾、卵巢囊肿的首选方法。     

超声引导穿刺治疗非寄生虫性肝囊肿

本义报道超声引导经皮穿刺引流并无水酒精灌注治疗非寄生虫性肝囊肿16例.囊肿直径平均8.6cm,囊液量平均528ml,无水酒精注入次数1-3次.14例囊腔完全消失,2例囊腔显著缩小.作者认为此创伤小、操作简便、疗效可靠,应作为非寄生虫性肝囊肿的首选治疗方法.     

CT引导下注射无水乙醇治疗肾囊肿

目的 总结CT引导下穿刺注射无水乙醇治疗肾囊肿的经验。方法 收集有随访病例45例62个肾囊肿经皮穿刺抽吸后注射无水乙醇治疗。囊肿直径4～13cm。用18～20G Chiba抽吸针穿刺抽吸，抽出囊液为25～690ml。注入99．7％的无水乙醇，乙醇量以抽出囊液的25％为宜。结果 本组随访时间2个月～2年，本组资料显示有效率达96．77％(60／62)。囊腔缩小2／3以上者达72．58％(45／62)，其中囊腔消失者37个，占所有囊肿数的59．68％。并发症为局部疼痛，无严重并发症。结论 CT引导下注射无水乙醇治疗肾囊肿是一种微创，并发症低，值得推广的治疗方法。     

Clinical and sonographic management of viable hydatid liver cysts

Aim

The aim of this study was to review our 18-year experience in the treatment of viable hydatid liver cysts (HLCs) with double percutaneous aspiration and ethanol injection (D-PAI) and to provide indications for the clinical management of HLCs.

Materials and methods

From January 1989 to December 2007, 127 patients (100 males; 13–80 years) with 184 viable HLCs (137 univesicular, 47 multivesicular; 2.8–20 cm) underwent D-PAI.

Results

Ultrasonography (US) showed complete disappearance of 125/184 (68%) cysts; in the remaining 59 cases, an inactive solid (37 cases, 20%) or liquid pattern (22 cases, 12%) was observed with volume decreases of 50–80%. The final US pattern was unmodified during the follow-up in 96.8%. Local recurrences were observed in 5 patients (3.9%): 4 patients with 8 multivesicular cysts and 1 patient with a bilocular cyst (with a solid pattern on US) that ruptured into the biliary tree 2 years after the procedure and disappeared after endoscopic sphincterectomy. The mortality rate was 0.8%, and the overall morbidity was 8.6%. The mean hospital stay was 2.9 days. The time of healing for smaller cysts (<5 cm) was shorter than that of large cysts (≥5 cm) (P < 0.001).

Conclusion

Our long-term results confirm the high effectiveness of D-PAI in the treatment of HLCs. These results suggest that multilocular cysts require closer follow-up than unilocular cysts.     

CT引导下经皮穿刺肝囊肿及肾囊肿硬化剂治疗的疗效分析

目的探讨CT引导下经皮肝囊肿、肾囊肿硬化剂治疗的临床应用价值。方法51例(肝脏囊肿20例,肾脏囊肿31例)经CT扫描确诊为单纯性囊肿的患者,囊肿大小自2.8cm&#215;3.5cm&#215;5.3cm~9.8cm&#215;15.6cm&#215;16.8cm不等。在CT导向下应用穿刺抽吸针抽出囊液,并注射硬化剂无水乙醇治疗,硬化剂注射量约为抽出囊液的25%。术后分别于3个月及半年后各复查一次CT扫描。结果51例肝脏囊肿及肾脏囊肿均一次穿刺成功,有效率为100%。半年后复查见49例完全消失或明显缩小,2例有缓慢复发迹象。51例中,46例于术后3个月复查一次,且中33例于术后半年复查第二次,另外5例于半年后复查1次,均未见复发。结论CT引导下经皮肝囊肿及/或肾囊肿硬化剂治疗有较高临床应用价值,且方便、安全有效。     

Percutaneous renal hydatid cyst treatment: long-term results

Background: To evaluate the effectiveness of percutaneous treatment of renal hydatid cysts. Methods: Four male and one female (14–52 years old, mean = 37 years) patients with five renal cysts were treated percutaneously. All five cysts from the patients were pure fluid collections, which were consistent with type I hydatid cysts according to Gharbi's classification. After entering the cystic cavity under sonographic guidance, cystic fluid was aspirated, and the cavity was filled with hypertonic saline (15% NaCl). In three patients with cysts larger than 6 cm in diameter, catheterization was performed under fluoroscopic guidance, and the cavity was filled with 95% absolute alcohol to sclerotize the cyst walls. In two patients with cysts smaller than 6 cm in diameter, the procedure was carried out by a technique in which the cyst was puncture aspirated, hypertonic saline solution was injected, and the cyst was reaspirated. The patients were followed by ultrasonography and computed tomography. Follow up was 5–62 months (mean = 33.8 months). Results: Sonographic follow-up examinations indicated a gradual decrease in cyst size and volume. The size reduction was significant (p < 0.05). The volume reduction rate was 55–95% (mean = 81%). During follow up, fluid components of all five cysts reduced gradually and finally disappeared, leaving a remnant that is called a ``pseudotumor appearance.' Neither mortality nor any dissemination was encountered during follow up. The only complication seen in this series was an abscess that was successfully treated with percutaneous drainage. Conclusion: According to the results of our study, percutaneous treatment of renal hydatid cysts avoids the morbidity of open surgery and preserves the residual function of the kidney. Received: 20 June 1996/Accepted: 31 July 1996     

超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿

目的 探讨彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿的治疗方法和临床应用价值.方法 对65例单纯性肝囊肿患者进行彩色多普勒超声引导经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗.结果 所有患者均一次性穿刺成功,成功率为100%,术后均放置中心静脉导管,经引流管共注射无水乙醇及抗生素各670次,平均每次注射保留时间约6.3 min.随访0.5~2.0年,26个脓肿均治愈,治愈率为100%,均未出现出血与感染性休克等并发症.结论 彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿,成功率和治愈率高,并发症少.     

CT引导下卵巢囊肿穿刺硬化治疗的探讨

目的总结CT引导下穿刺硬化剂治疗卵巢囊肿的方法及治疗效果。方法22例卵巢囊肿在CT定位下经皮穿刺抽吸,行无水乙醇反复冲洗法硬化剂治疗,其中单纯囊肿18例,巧克力囊肿4例,用18～22G穿刺针抽吸,注入99.7%无水乙醇。抽出囊液量为30～500ml,注射量为抽出量的25%～30%。术后每隔3个月复查,随访其疗效。结果22例病人囊肿均穿刺成功,随访3个月到1年,复查见16例囊肿消失,6例囊肿缩小50%以上(包括4例巧克力囊肿),有效率100%,无严重并发症。结论CT引导下经皮穿刺硬化剂治疗卵巢囊肿是一种安全,有效的治疗方法,具有较高的临床实用价值。     

CT引导下介入治疗腹部囊肿45例的体会

目的 探讨在CT引导下经皮穿刺抽吸并应用无水酒精治疗腹部囊肿的应用价值.方法 对45例腹部囊肿在CT引导下经皮穿刺抽吸后注射无水酒精,其中肝囊肿24例,肾囊肿18例,胰腺假性囊肿3例.术后CT或/和超声随访观察疗效.结果 治愈率为78%（36/45）,显效率20%（9/45）,有效率100%（45/45）,无副反应发生.结论 CT引导下介入治疗腹部囊肿疗效显著,且操作方法简单安全,具有较高的临床应用价值.     

肝囊肿的超声介入治疗

作利用医用无水乙醇具有使细胞质脱水、凝固坏死的特性对20例肝囊肿进行了超声介入治疗．其中，男性7例．女性13例、平均年龄57岁。囊肿为20～150mm不等。经一或多次重复治疗后．随访3～6个月发现：8例肝囊肿彻底消失．12例肝囊肿有所缩小(P<0.01)。无水乙醇作用于囊肿内壁上皮细胞．使该细胞凝固坏死，失去其分泌功能．达到治疗目的。作认为．25％的替代容量最为理想，但最多不宜超过20ml，它既能与囊肿内壁的各个部份接触．又不致于产生过高的局部压力使乙醇外渗．无水乙醇的超声介入治疗是肝囊肿治疗中一个简便、实用且安全的方法．可替代传统的开放引流及外科手术切除．值得临床推广。     

Percutaneous sonographically guided treatment of hydatid cysts in sheep: direct injection of mebendazole and albendazole.

OBJECTIVE: The purpose of this study was to investigate the scolicidal effect of intracystic injection of benzimidazolic solutions in naturally infected sheep with hydatid disease. METHODS: Twenty-four sheep with 37 hydatid cysts were included in this study for percutaneous treatment with benzimidazolic solutions. The animals were divided into 3 groups: group I, treatment group with mebendazole; group II, treatment group with albendazole; and group III, control group with distilled water. All solutions were given percutaneously under sonographic guidance. Cyst contents were aspirated with a needle, and then scolicidal solutions were injected into the cysts; reaspiration was not done. Routine follow-up sonographic images were taken on the 15th day after treatment, then once per month for 3 months, and then at 3-month intervals thereafter. At the 1-month follow-up, the percutaneous aspirate yielded orange juice-like material containing necrotic debris without living scolices. RESULTS: Sonography showed a reduction in cyst size in the benzimidazolic groups (groups I and II) and progressive changes in echo patterns. An anaphylactic reaction was observed during the procedure in 1 animal. After 12 months of sonographic follow-up, the animals in all groups were killed, and macroscopic and microscopic changes in tissue samples were evaluated. At autopsy, no cysts with living scolices were found in the benzimidazolic groups, and the appearance of the treated cysts was different from that of those in the control group. Microscopic examination showed the degeneration, necrosis, and thickening of the cyst walls in the treatment groups. CONCLUSIONS: Intracystic injection of benzimidazolic solutions as scolicidal agents may be used for percutaneous treatment of hepatic hydatid cysts in sheep.     

肝肾囊肿 CT引导介入治疗后疗效观察

目的　CT导引下肝肾囊肿穿刺抽吸硬化治疗及疗效观察。方法　肝囊肿 18例 ,肾囊肿 3 1例 ,肝肾囊肿共计49例 ,囊肿大小为 3 .8～ 11.2cm ,使用 2 0G ,7.5～ 15cm长度的穿刺针 ,抽出囊液 2 2～ 480ml ,注入 99.7%的无水酒精 ,治疗后对所有病例进行随访 ,最长为一年。结果　总有效率为 10 0 % ,治愈率为 85 .7% ,无并发症。结论　此疗法操作简单 ,定位准确 ,创伤小 ,疗效好 ,是一理想的治疗手段。     

超声造影引导下经皮经肝注射无水乙醇治疗肝癌的临床观察

目的：探讨超声造影引导下经皮经肝注射无水乙醇治疗肝癌的可行性和有效性 方法：对我院2013年3月至2015年5月，病理证实的原发性肝癌患者86例，共计107个病灶，行超声造影引导下经皮经肝无水乙醇注射治疗肝癌，并行超声造影对其疗效进行观察。 结果：107个病灶经超声造影引导下行经皮经肝无水乙醇注射治疗后，经超声造影评价，局部消融成功率达到100%，随访时间6月至2年，肿瘤局部进展率5.6%（6/107），未发现严重消融相关并发症。 结论：超声造影引导下行经皮经肝无水乙醇注射治疗肝癌，可以有效的杀灭肿瘤组织，是一种临床可行有效的介入治疗肿瘤的方法。     

849例肝包虫囊肿超声引导下穿刺硬化治疗的疗效评价

目的对比分析我院19年间849例肝包虫囊肿患者1116个肝包虫囊肿超声引导下穿刺硬化治疗的疗效。方法 1992年7月至1999年12月我院门诊及住院的257例肝包虫囊肿患者共321个包虫囊肿,均采用传统的经超声引导穿刺硬化治疗,为传统组。2000年1月至2010年6月我院门诊及住院的592例肝包虫囊肿患者共795个包虫囊肿,均采用改进和规范的经超声引导穿刺硬化治疗,为规范组。传统组与规范组的肝包虫囊肿均在超声引导与监视下进行穿刺完成硬化治疗的全过程。规范组在技术操作中注意选择最佳路径、一次进针到位、进针抽吸同步、立即迅速减压、务必抽净囊液、选用无水乙醇、注入总量要多、多次硬化治疗、滞留时间须长、适当变动体位、避免气体进入及应保留硬化剂等关键环节。结果 849例患者穿刺成功率为99.76%(847/849);传统组与规范组的穿刺治疗有效率分别为97.28%(250/257)及99.16%(587/592);传统组与规范组的穿刺并发症发生率分别为3.11%(8/257)及1.35%(8/592),规范组明显低于传统组,差异有统计学意义(P<0.01);传统组与规范组的穿刺治疗后复发率分别为1.94%(5/257)及0.34%(2/592),规范组亦低于传统组,差异有统计学意义(P<0.01);单纯囊肿型(含内囊分离型即Ⅰ和Ⅱ型)635例(74.79%)、子囊型214例(25.21%),治疗有效率分别为99.37%(631/635)及96.26%(206/214);肝包虫囊肿直径≤49mm161例(18.96%)、50～99mm610例(71.85%)、≥100mm78例(9.87%)者治疗有效率分别为99.38%(160/161)、98.85%(603/610)、94.87%(74/78)。结论超声引导穿刺是治疗肝包虫囊肿的首选手段,注意规范技术操作中的各个环节,可显著提高疗效。     

超声引导下经皮穿刺置管多次灭能术治疗囊肿的价值

目的 探讨安全高效的囊肿治疗方法.方法 对65例(肝、肾、卵巢)囊肿患者, 采用超声引导下穿刺置入COOK公司产7F引流管行囊肿穿刺、引流、灭能术治疗,并留置引流管2～3 d,用无水乙醇对囊肿壁灭能2～3次.结果 随访1.5年,65例患者中囊肿消失痊愈61例,痊愈率93.8%;囊肿明显缩小(直径＜1/3)但仍残有囊腔3例,总有效率98.5%;复发1例.无腹腔出血及化学性腹膜炎发生.结论 应用超声引导下经皮穿刺置管多次灭能术治疗囊肿方法安全有效.     

肝巨大包虫囊肿超声引导下穿刺硬化治疗的方法学研究

目的 旨在对肝脏巨大包虫囊肿超声引导下穿刺硬化治疗的方法学进行探讨,以期取得更佳疗效.方法 穿刺硬化治疗中须注意选择最佳路径、进针抽吸同步、必须迅速减压、务必抽净囊液、选用无水乙醇、注入总量要多、多次硬化治疗、滞留时间须长、适当变动体位、避免气体进入及应保留硬化剂等14个技术操作的关键环节.结果 穿刺成功率100%,硬化治疗有效率100%,无并发症.结论 超声引导下穿刺是治疗肝脏巨大包虫囊肿的首选手段,注意规范技术操作中的各个环节,可显著提高疗效.     

Complications of percutaneous ethanol ablation.

Percutaneous ethanol injection therapy performed with sonographic visualization is a steadily growing therapeutic method that can be used in the ablation of solid and cystic masses in a variety of anatomic locations. Ethanol has been used for many years as an angiographically administered agent for vascular embolization of tumors such as hepatic and renal neoplasms. It was first used as a percutaneously injected agent for the sclerosis of renal cysts. Local infiltration or intravascular injection of ethanol leads to cell death by causing cell membrane lysis, protein denaturation, and vascular occlusion. Because of the initial success in the sclerosis of renal cysts, percutaneously injected ethanol is now used in the ablation of hepatic cysts and solid tumors, such as hepatocellular carcinomas. As a treatment agent, ethanol combines the benefits of being widely available, inexpensive, efficacious, and relatively easy to administer. Optimal results require that the radiologist have considerable experience in ultrasonographic scanning techniques and facility with percutaneous needle insertion under real-time visualization. Alternatively, the radiologist may choose CT as a method to visualize needle placement. Percutaneous ethanol injection therapy usually is an effective alternative to conventional surgical resection of liver lesions and has a low complication rate. We present two patients in whom hypotensive complications occurred during percutaneous ethanol injection therapy and discuss the likely causative mechanisms.