应用深静脉穿刺针穿刺引流肝脓肿47例体会

1987年7月至1996年12月我院采用深静脉穿刺计经皮穿刺肝脓肿置管引流法，治疗直经＞5．0cm的肝脓肿患者47例，其方法简便，疗效满意，现报道如下。亚临床资料本组47例，男32例，女15例，年龄10～75岁，平均42岁。本组病例均经B超或CT检查，结果：单发脓肿历例（74．5％），多发脓肿12例（25．5％）；脓肿直径为5．5－18．0cm；脓肿位于右肝33例，左肝12例，左右肝2例。47例患者均在B超引导下，采用深静脉穿刺针行肝脓肿穿刺置管引流，其脓液行细菌培养。结果：细菌性肝脓肿38例，阿米巴肝脓肿9例。经该法治疗，全组病例均痊愈，平均留管时…     

细菌性肝脓肿的放射介入治疗

目的：探讨放射介入治疗（或联合经皮肝脓肿穿刺引流）治疗细菌性肝脓肿的效果。方法：回顾性分析65例细菌性肝脓肿病人（其中2例行介入治疗）的临床资料。结果：介入组无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，3例死于多脏器功能衰竭，病死率（7．7％）高于介入组，但差异无显著性（P＞0．05）；介入组病人的退热时间和脓肿消退时间均显著短于对照组（均P＜0．05）。结论：介入治疗细菌性肝脓肿的效果优于传统治疗方法。     

B超引导下经皮肝穿刺治疗细菌性肝脓肿93例效果分析

目的探讨B超引导下经皮肝穿刺在细菌性肝脓肿治疗中的临床应用价值。方法1995年10月—2004年2月，对接诊的93例细菌性肝脓肿患者实施B超引导下经皮肝穿刺抽吸或置管药物冲洗引流术．其中34例单纯穿刺抽脓．59例穿刺后置管药物冲洗引流。结果93例细菌性肝脓肿患者中91例经皮肝穿刺抽吸或置管药物冲洗引流治愈，2例中转手术，治愈率达97．8％。结论B超引导下经皮肝穿刺治疗细茵性肝脓肿具有安全、微创、廉价、高效、随时施治的优点，可作为临床治疗细菌性肝脓肿的首选方法。     

糖尿病合并细菌性肝脓肿的诊断和治疗

目的：探讨糖尿病合并细菌性肝脓肿的临床特点,以提高治疗水平。方法：对54例患者的临床资料进行回顾性分析。结果：糖尿病合并细菌性肝脓肿不明感染源者63．0％。有典型症状者仅53．7％。并发感染性休克和急性肾功能不全者各5例,酮症酸中毒和高渗性昏迷各2例,肝脓肿溃破而致腹膜炎1例。单纯用抗生素治疗者20例,B超引导经皮肝穿刺置管引流17例,手术治疗17例。治愈51例（94．4％）,死亡3例。结论：糖尿病合并细菌性肝脓肿发病隐匿,严重并发症多,易误诊误治。早期诊断、控制血糖、适时脓肿引流和有效抗生素应用是治疗成功的关键。     

细菌性肝脓肿外科处理的临床分析

目的总结细菌性肝脓肿的诊治经验。方法对我院从1992年-2002年十年间所收治的105例细菌性肝脓肿病人进行回顾性分析。本组治疗方法包括：单纯抗生素治疗21例,外科手术引流30例,腹腔镜手术引流6例,经皮穿刺抽吸治疗42例,经皮穿刺置管引流治疗6例。结果本组治愈101例,死亡4例,死亡率3．8％。结论早期诊断和恰当的治疗是提高细菌性肝脓肿疗效的重要因素,超声引导下穿刺抽吸和／或置管引流已成为细菌性肝脓肿的治疗首选,适合于大部分病人。而外科手术引流仅适合于介入治疗失败或脓肿破裂病人。     

细菌性肝脓肿经皮肝穿刺与手术治疗疗效对比

目的：比较经皮肝穿刺与手术治疗细菌性肝脓肿的疗效。病例和方法：１９９０年１月至１９９６年３月的６年中，瑞金医院外科收治了３８例细菌性肝脓肿病人，其中２２例作经皮肝穿刺引流，１６列经腹手术引流。两组病人年龄、病灶大小及部位、病情程度等无明显差异，对两种治疗方法作了疗效观察。结果和结论：经皮肝穿刺引流成功的病人在饮食、血象、体温恢复正常时间以及抗生素应用时间、住院等方面明显优于经腹手术引流组，此外在输     

糖尿病合并细菌性肝脓肿的临床特点与微创治疗

目的：探讨糖尿病合并细菌性肝脓肿的临床特点与微创治疗。方法：总结我院2004年2月至2009年9月收治的46例糖尿病合并细菌性肝脓肿病人的临床资料。32例在静脉应用胰岛素、抗菌素控制血糖与感染的基础上,南B超引导下行肝脏脓肿穿刺引流,其中4例同时行ERCP胆管取石结合鼻胆管引流;6例行腹腔镜探查、肝脓肿切开引流,其中4例同时行腹腔镜胆囊切除术;另8例采用保守治疗。结果：经保守治疗治愈8例,B超穿刺脓肿引流或腹腔镜脓肿切开引流治愈24例,脓腔缩小好转出院8例;临床治愈率达95．7％。另有2例病人脓肿穿刺引流后因中毒性休克并发心、肺、肾多脏器功能衰竭死亡,病死率为4．3％：4例病人行脓肿引流后出血,经保守治疗后而痊愈。结论：在积极控制血糖,有效控制感染的基础上,采用B超或腹腔镜微创技术引流脓肿,是糖尿病合并细菌性肝脓肿病人的首选治疗方法。     

小儿细菌性肝脓肿的诊断和治疗

目的 总结小儿细菌性肝脓肿的诊治经验。方法 对44例小儿细菌性肝脓肿进行回顾性分析。结果 （1）本病主要致病菌是葡萄球菌;（2）高热、寒颤及白细胞增高是本病的主要临床表现;（3）非手术治疗25例（56.8%),手术引流及穿刺抽脓各9例,肝叶切除1例,全部病例痊愈。结论 （1）辅助检查首选B超;（2）根据肝脓肿的分期及部位而选择不同的治疗方法。     

经皮置管引流治疗肝脓肿152例报告

作者报告在Ｂ超引导下，采用粗针经皮穿刺直径在５ｃｍ以上的肝脓肿置管引流（ＰＣＤＨＡ），疗效满意。其中细菌性肝脓肿１２７例，阿米巴肝脓肿２５例。单发脓肿１３６例（右肝１１１例，左肝２５例），多发脓肿１６例。共计脓腔２０３个，与同期手术引流４１例肝脓肿病例比较，它具有创伤小，并发症少，治愈率高，住院时间短，较手术安全等优点。与穿刺抽吸比较，因它是一次性置管持续引流，可以减少毒血症，有利于脓腔闭合，避免多次穿刺对肝脏的损伤。半年后脓肿复发率只占１．３％，且还可再用ＰＣＤＨＡ治愈。作者介绍了穿刺技术和遇到几个具体问题的解决办法。     

超声引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿临床分析

目的探讨B超引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿的临床意义。方法采用B超介导下经皮肝穿刺置管引流治疗肝脓肿48例,其中单发脓肿39例（81.2%）,2个以上多发脓肿9例（18.8%）。脓肿部位,肝右叶32例（66.7%）,肝左叶9例（18.7%）,左右肝叶7例（14.6%）。结果病人在置管后平均3d体温恢复正常及症状消失,引流量逐渐减少和消失,B超检查证实脓腔萎陷及无脓液。本组48例全愈,治愈率100%,其中42例获得随访,随访时间1～3年,所有病人均恢复正常工作。结论B超介导下经皮肝穿刺置管引流术是一种操作简便的肝脓肿引流方法,医疗费用低,成为肝脓肿的首选治疗方法。     

化脓性肝脓肿的经皮引流和抗菌药物治疗

本文报告１９８５年以来用经皮引流和抗菌药物为主治疗２４８例肝脓肿的经验，９５．２％的病例经Ｂ超检查确诊，有明确脓腔的脓肿行经皮置管引流或穿刺吸脓共１０５例；未液化的８９例脓肿，给以抗菌药物及支持治疗，手术治疗５４例，为肝脓肿破溃腹膜炎，或胆源性肝脓肿需急诊处理胆道病变，或经皮引流不畅中转手术。作者认为，由于Ｂ超用于诊断和鉴别以及新一代抗生素的应用，肝脓肿的预后已大为改善，本组死亡率为１．６％，经皮     

手术配合中药坐浴治疗婴幼儿肛周脓肿疗效观察

为探讨手术配合中药坐浴治疗婴幼儿肛周脓肿的疗效,将86例肛周脓肿患儿随机分为治疗组与对照组,每组43例,治疗组采用手术加中药坐浴治疗,对照组采用手术切开引流或切开挂线术治疗,观察两组治疗效果。结果显示,治疗组与对照组治愈率分别为95．3％和65．1％,两组疗效差异具有统计学意义（P〈0．05）。结果表明,婴幼儿肛周脓肿采用手术配合中药坐浴治疗能取得较好的疗效。     

改成熟型肝脓肿引流术为清除术的25例报告

目的:探讨以肝脓肿清除术取代传统肝脓肿引流术的可能性和方法。方法:对25例细菌性肝脓肿病人进行回顾性分析;22例采用冲洗、烧灼、加网膜填塞的方法(即“冲、烧、填”法),对另3例肝慢性坚壁脓肿(其中1例合并经久不愈的窦道)施行肝切除,从而达到完全清除脓肿组织的目的。结果:22例冲、烧、填法治疗的病人手术一次成功,不置引流物;术后7～9d出院,无一例切口感染;随访1～12年,无任何后遗症。3例肝切除者也获满意疗效。结论:肝脓肿清除术与传统引流术相比,具有治疗全过程时间短、费用低、疗效好及并发症少的优点,值得推广应用。     

肝脓肿的诊断和治疗

目的探讨细菌性肝脓肿的诊断和治疗方法,总结治疗经验,提高治疗效果。方法回顾性分析2000年1月-2008年12月108例细菌性肝脓肿诊断和治疗方法的临床资料。男74例,女34例,年龄最小20岁,最大78岁。左肝脓肿21例,右肝脓肿75例,双侧肝脓肿12例。单个脓肿78例,多发脓肿30例。脓腔最大12cm,最小3cm。结果内科保守治疗15例,11例治愈,4例转外科手术治疗;CT指引下穿刺抽脓5例,B超引导下穿刺抽脓52例,穿刺次数1～4次,共治愈55例,2例转手术切开引流;外科切开引流治愈42例。结论多个散在性肝脓肿以内科治疗为主。单个肝脓肿直径大于6cm者,多需切开引流;小于6cm者可在CT或B超导引下穿刺抽脓治疗,尤其是在B超导引下穿刺抽脓治疗,操作简便,效果好,可作为肝脓肿直径在6cm以下者的首选治疗方法。     

Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage

A retrospective review of 39 patients with pyogenic hepatic abscess treated from 1977 through 1984 included 23 patients who were surgically treated and 16 who underwent percutaneous drainage. The average age in each group was similar (about 55 years). The most common cause of abscesses in each group was biliary tract disease. Abscesses caused by portal seeding and local extension were more common in the surgical group, 14 of whom required additional surgical procedures at the time of surgical drainage. Of the 16 patients in the percutaneously drained group, seven were seen during the immediate postoperative period. Most of the abscesses occurred in the right lobe of the liver, but single abscesses in the left lobe (30%) and multiple abscesses (57%) were more common in the surgical group. Klebsiella enterobacter and group D streptococcus were most common in the surgically and percutaneously drained groups, respectively. All patients received antibiotics, with a mean length of treatment of 14 days. Mean time to defervescence was about four days in both groups, with a longer hospital stay for the percutaneously drained group (26 vs 46 days). Morbidity was high in both groups (surgical, 48%; percutaneous, 69%). Three of the percutaneously treated patients required surgical drainage because of highly viscous abscess contents. Mortality was 17% in the surgical group and 13% in the percutaneously drained group. Percutaneous drainage with computed tomography probably should be the initial drainage procedure in patients with pyogenic hepatic abscesses in whom no concomitant surgical procedure is planned. Regardless of treatment, the morbidity and mortality remain high.     

Pneumoperitoneum Following the Spontaneous Rupture of a Gas-Containing Pyogenic Liver Abscess: Report of a Case

We report herein the case of a ruptured liver abscess that resulted in pneumoperitoneum. A patient with diabetes mellitus presented with symptoms of acute abdomen. The plain abdominal radiograph and computed tomography findings revealed abdominal free air and a gas-containing liver abscess, whereby a diagnosis of a ruptured liver abscess was made. An emergency operation was performed, and the abscess was drained followed by peritoneal lavage and the administration of appropriate antibiotics. To the best of our knowledge, very few cases of spontaneous pneumoperitoneum occurring secondary to the rupture of a gas-containing liver abscess have been encountered in Japan. Received: February 10, 2000 / Accepted: July 25, 2000     

切开引流加挂线术一次性治疗婴幼儿肛旁脓肿

目的：探讨提高婴幼儿肛旁脓肿一次性治愈率的方法。方法：回顾分析3年来收治的79例肛旁脓肿病例．其中42例为单纯切开引流．37例在切开的同时行挂线治疗。结果：切开组治愈率64．3％，切开挂线组治愈率94．6％．两组有显著差异。结论：切开引流加挂线术是一种理想而简便的治疗婴幼儿肛旁脓肿的方法．正确地寻找及处理内口是手术成功的关键。     

Developmental aspect of renal suppurations. Apropos of 2 cases

The authors set out to differentiate between two types of renal parenchymal suppuration in the light of two personal cases treated recently - renal abscess and localized acute bacterial nephritis (LABN), which is perhaps no more than a preliminary stage in the formation of a renal abscess. Case 1 concerns a LABN, diagnosed by CT scan. The treatment was purely medical and monitoring scans show no anomalies. Case 2 was a gathered abscess, also diagnosed by CT scan, and treated by surgical drainage. The interest of the differentiation between these two types of suppuration is essentially therapeutic. Once gathered, the abscess must be drained surgically, whereas the LABN can be treated medically, with close supervision to ensure complete cure. The differential diagnosis between the two is mainly by scanner, with a study of the respective densities.