超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿

目的:探讨超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿的临床应用价值。方法:对细菌性肝脓肿患者39例51个病灶实施超声引导下经皮穿刺,5cm的肝脓肿直接穿刺抽吸治疗,5cm的肝脓肿置管引流。结果:27例脓肿5cm者,1次抽吸治愈率85.2%(23/27),2次抽吸治愈率占14.8%(4/27)。12例脓肿5cm者行置管引流治疗,患者均在穿刺引流24～48h后体温降至正常,临床症状改善。结论:超声引导穿刺置管引流治疗细菌性肝脓肿安全、简便、有效,可作为临床治疗细菌性肝脓肿的首选方法。     

高频彩超引导置管引流治疗软组织脓肿的临床价值

目的 探讨高频彩超引导下置入套管针引流浅表软组织脓肿的疗效。方法 选择各部位软组织脓肿13例，在高频彩超引导下，经预定方向置入PTC针或套管针，留置脓腔内进行置管引流，部分较大脓腔用生理盐水冲洗，抗生素注药治疗。结果 13例患者全部一次置管成功，其中2例多发脓肿经2次置管，引流时间最短2d，最长12d撤管，诊断和治愈率100％，疗效显著，无任何并发症。结论 高频超声引导下置管引流软组织脓肿，改变了传统的外科手术切开引流，具有创伤小，恢复快，疗效好的特点，是一种有效的治疗方法。     

彩色多普勒超声在肝脓肿诊断及引导穿刺置管引流治疗中的价值

目的 探讨在肝脓肿诊断及穿刺置管引流治疗引导中彩色多普勒超声(CDUS)的临床应用价值.方法 应用CDUS对2012年3月至2014年6月收治的46例肝脓肿患者进行肝脏检查,分析其超声图像特点,并与肝穿刺、病理结果对比;治疗上行CDUS引导下穿刺置管引流,观察其治疗疗效.结果 46例最终均经超声引导下肝穿刺及病理检查确诊为肝脓肿,经CDUS诊断为肝脓肿44例,诊断符合率95.7％.46例患者穿刺置管引流治疗后3～5h体温即下降,穿刺成功率以及治愈率均达100％.无1例出现严重感染、大出血、气胸以及胆漏等并发症.结论 CDUS诊断肝脓肿的准确率很高;采用CDUS引导下穿刺置管引流治疗肝脓肿,方法直接、安全、易于操作,且穿刺成功率及治愈率高.     

普通超声探头引导经皮肝穿刺置管引流治疗肝脓肿

目的探讨普通超声探头引导经皮肝穿刺置管引流治疗肝脓肿的临床应用价值。方法对41例肝脓肿患者53个病灶行普通超声探头引导经皮肝穿刺置管引流术,直径〈50mm肝脓肿给予穿刺注药冲洗治疗,直径≥50mm肝脓肿行置管引流术。结果41例肝脓肿患者的53个病灶一次穿刺置管成功率100％,无并发症发生。穿刺置管抽液后患者体温即下降,有效率100％。2周治愈率达到65．9％,4周治愈率达到100％。结论利用普通探头引导进行穿刺置管引流治疗肝脓肿,具有安全有效、微创,费用低廉及操作简便、灵活的特点,值得推广应用：     

超声引导下经皮穿刺置管引流治疗肝脓肿的临床疗效及预后观察

目的观察超声引导下经皮穿刺置管引流(PCD)治疗肝脓肿的临床疗效及预后。方法选择2016年5月～2018年5月我科收治的肝脓肿患者48例,随机分为观察组和对照组各24例。对照组实施超声引导下经皮穿刺针单纯抽吸治疗,观察组实施PCD治疗,比较两组患者治疗效果、临床症状消失时间、住院时间及并发症。结果观察组疼痛消失时间、脓肿消失时间、体温恢复时间及住院时间均短于对照组,差异有统计学意义(P<0.05);两组治疗总有效率及并发症发生率比较,差异无统计学意义(P>0.05)。结论在肝脓肿中应用PCD治疗效果较好,可有效缓解患者临床症状,且并发症少,安全性较高。     

经皮穿刺置管引流术在腰椎结核治疗中的作用

目的 探讨B超引导下经皮穿刺置管引流(PCD)治疗腰椎结核伴脓肿形成的疗效.方法 回顾性分析B超引导下PCD治疗腰椎结核伴脓肿形成39例的临床资料.所有患者均在B超引导下行经皮穿刺置管引流,31例单纯采用PCD治疗,8例采用PCD结合腰椎稳定手术,应用结核临床治愈标准对患者进行疗效评估.结果 1例置管部位形成皮肤窦道,经局部换药3周后治愈;1例交叉感染,经引流及应用敏感抗生素后治愈.随防其中35例,随访时间1～4年,平均36个月,所有患者达到临床治愈.结论 PCD是一种引流术,适合较大的未分隔的稀薄脓肿.     

超声引导下穿刺抽吸置管治疗肝、肾脓肿

目的评价超声引导下穿刺抽吸、置管治疗肝肾脓肿的效果.方法对39例肝肾脓肿患者共39个脓腔进行穿刺抽脓、冲洗、注药或穿刺置管引流、定时冲洗、注药治疗.结果32例患者行穿刺抽脓冲洗注药1～3次;7例患者行穿刺置管引流冲洗注药.穿刺及置管成功率均达100%.经超声复查,39例患者脓肿完全吸收,全部痊愈.结论超声引导下穿刺抽吸及置管术是一种疗效显著、安全、微创的治疗方法,具有重要的临床应用价值.     

B超引导下穿刺置管引流术治疗肝脓肿22例临床分析

目的 探讨超声引导下经皮肝穿刺抽脓或置管引流在细菌性肝脓肿的临床应用价值。方法对22例细菌性肝脓肿通过超声引导确定后进行穿刺抽脓或置管引流,其中4例行穿刺抽脓1次,21例行置管引流。结果22例穿刺、置管全部获成功,平均疗程20d（10～42d）。术后无腹腔内出血、气胸、脓胸及严重腹腔感染等并发症。结论B超引导下肝脓肿穿刺置管引流术具有简便、安全、住院时间短、费用少,并发症低的优点,可用于治疗大多数肝脓肿。     

超声引导下置管引流治疗艾滋病合并巨大肝脓肿的应用价值

目的探讨超声引导下置管引流治疗艾滋病合并巨大肝脓肿的临床应用价值。方法回顾性分析超声引导下置管引流治疗20例艾滋病合并巨大肝脓肿患者的临床资料。结果 (1)脓肿直径10.1～21.6 cm,平均(12.4±2.8)cm。(2)置管1周后炎症指标明显下降,2周后肝功能明显好转,脓肿缩小。(3)置管引流后治愈者16例(80%),引流后再次行外科手术治疗者4例(20%)。(4)置管引流时间5～77 d,中位数为19 d,住院时间12～90 d,中位数为29 d。(5)20例患者术后均未发生并发症及未发生医护职业暴露。结论超声引导下置管引流治疗艾滋病合并巨大肝脓肿安全、有效、损伤小、患者易耐受。     

超声引导下置管引流在肝移植术后腹腔并发症中的应用

目的探讨超声引导下置管引流在原位肝移植术后腹腔并发症中的价值。方法回顾40例在超声引导下采用Seldinger法置管引流治疗原位肝移植术后腹腔并发症的资料。结果40例超声引导下置管引流均一次成功,包括肝内胆汁瘤置管3例,经皮肝内胆管置管3例,胆漏置管12例,膈下积液置管引流9例,腹腔积液置管引流13例。其中13例为导管堵塞或分隔性积液而重新置管。置管后分别引流出胆汁、脓液或积液,引流后症状有不同改善,无严重并发症发生。结论超声引导下置管引流对原位肝移植术后腹腔并发症有重要价值。     

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抗生素冲洗治疗老年肺脓肿

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抗生素冲洗治疗老年肺脓肿的治疗方法和临床应用价值。方法对58例老年肺脓肿患者进行了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抗生素冲洗法治疗。结果所有患者均一次性穿刺成功,成功率100%,术后使用氯化钠和抗生素稀释后反复抽洗脓腔,直至脓液相对减小或闭合时,拔出引流导管,随访0.5～3年,56个肺脓肿治愈,治愈率96.6%,均未出现出血与气胸等并发症。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抗生素冲洗治疗老年肺脓肿,成功率和治愈率高,并发症少。     

Ultrasound guided percutaneous drainage of abdominal abscesses in the hands of the clinician: a multicenter Italian study

Objective: Image guided percutaneous drainage is a well established therapeutic technique. The results of these procedures, when performed directly by the clinician and under sonographic guidance, in respect to other imaging techniques are not yet clarified. Methods: The 886 cases of ultrasound guided drainage were collected from eight italian clinical institutions and the results were analyzed according to location of the abscess, drainage technique, underlying diseases, microbiological findings, immunological patient status and previous surgical intervention. Results: We observed an overall cure rate of 90.4%. The best results were obtained in hepatic abscesses, both amoebic and pyogenic (cure rate 98.7 and 94.3%). Slightly lower cure rates were obtained in abdominal and splenic abscesses, postoperative collections and severely immunocompromised patients. The frequency of complications was low (6.6%) and mostly related to catheter drainage. No drainage-related deaths occurred. Conclusions: The study confirms the high clinical efficiency and safety of ultrasound guided percutaneous drainage, even when performed directly by the clinician. The sonographic guidance showed similar efficacy, more manageability and lower costs than other imaging techniques and it should be preferred whenever possible. For hepatic abscesses, ultrasound guided needle aspiration showed good results and less complications than catheter drainage.     

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.     

超声定位下穿刺治疗乳腺脓肿36例临床效果观察

目的探讨超声定位下,穿刺治疗乳腺脓肿替代传统脓肿切开引流术的可行性。方法哺乳期急性化脓性乳腺炎患者36例,在超声定位下穿刺乳腺脓腔,抽吸脓液,用含抗生素溶液冲洗脓腔。结果本组36例共穿刺104例次,平均2.8次/例。拔针后暂时出现漏液3例,无需特殊处理,1～2天后自行愈合;13例经3次治疗痊愈;19例经4次治疗痊愈;4例经5次治疗痊愈。随访4周至6个月,无复发病例,局部无瘢痕,恢复哺乳20例,治愈率100%。结论超声引导穿刺治疗乳腺脓肿创伤小,恢复快,无手术疤痕,简便安全可靠。     

CT引导下经皮穿刺抽液引流诊治急性胰腺炎局部并发症(附24例报告)

目的:探讨CT引导下经皮穿刺抽液和/或外引流在诊治急性胰腺炎局部并发症中的临床应用价值。方法:回顾分析2002年3月至2006年12月在我院行CT引导下经皮穿刺诊治的急性胰腺炎局部并发症的24例患者的临床资料,其中急性液体积聚6例、胰腺坏死3例、胰周脓肿6例、假性胰腺囊肿9例。检查穿刺液是否伴感染、含淀粉酶情况,随访临床症状、引流效果和影像学的改变。结果:共穿刺28例次,穿刺成功率100%,20/24例(83.33%)穿刺抽出积液后感局部胀痛缓解。可及时确诊感染性坏死,但引流效果差。2/6例(33.33%)胰周脓肿穿刺引流后治愈,4/6例引流效果差需开腹手术。5/9例(55.56%)假性胰腺囊肿经1.5～6月外引流后治愈拔管,4/9例(44.44%)转行内引流术。结论:CT引导下穿刺检查和外引流成功率高,并发症少。通过穿刺可明确是否伴有感染、了解引流物的性状,为制定治疗方案提供依据,可安全用于诊断和治疗一些急性胰腺炎的局部并发症。     

Ultrasound-guided diagnostic and therapeutic interventions in peripheral pulmonary masses

The value of ultrasound guided transthoracic biopsy and abscess drainage was assessed in 155 patients with thoracic consolidations adjacent to the chest wall. Biopsies were performed with 18- or 19-gauge tissue core biopsy needles. Correct diagnosis was achieved in 91% (92% in neoplasmas, 87% in non-neoplastic consolidations). Ultrasound guided percutaneous lung abscess drainage was successful in 13 cases. Six patients developed complications: one small pneumothorax, two pneumothoraces requiring a chest tube, two mild and one moderate hemoptyses. Ultrasound guided transthoracic biopsy is an accurate, safe and well-tolerated procedure. It provides adequate specimens for routine histologic examination and also permits successful drainage of pulmonary abscesses.     

Hepatic abscesses in immunocompromised patients: Ultrasonically guided percutaneous drainage

Ultrasonically guided percutaneous drainage (US-PD) is considered first-line therapy for hepatic abscesses, but no data are available on its efficacy in severely immunocompromised patients. Therefore, we examined 15 such patients in whom one or more hepatic abcesses of different etiology were treated with US-PD. Eleven patients underwent needle aspiration and four had catheter drainage under US guidance. In 12 cases we achieved complete healing of the abscesses. In one case, clinical improvement was obtained but surgery was required for cure. In another case (fungal abscess in AIDS), we had no improvement and the patient died. No procedural complications were observed. Seven patients died during the follow-up periods of up to 49 months from their underlying disease. We conclude that US-PD must be considered the therapy of choice for hepatic abscess (except the fungal lesions) in severely immunocompromised patients.     

超声引导下微创治疗乳腺脓肿的价值

目的探讨超声引导下微创治疗乳腺脓肿的临床价值。方法 2008年1月至2011年1月我院收治56例乳腺脓肿患者共78个脓肿病灶。单侧乳房脓肿34例,双侧乳房脓肿22例。脓肿最大为9cm×7cm×4cm,最小为3cm×3cm×2cm。30例患者共42个脓肿病灶采用超声引导下微创治疗,26例患者共36个脓肿病灶采用传统手术治疗。结果行超声引导下微创治疗患者术后切口愈合及术腔完全闭合时间为7～9d,行传统手术治疗患者为9～20d,差异有统计学意义(P=0.045)。行超声引导下微创治疗患者术后切口瘢痕长度为0.3～0.5cm,小于行传统手术治疗患者的3～5cm。行超声引导下微创治疗患者一次手术治疗成功率为97.6%(41/42),行传统手术治疗患者一次手术治疗成功率为83.3%(30/36),差异有统计学意义(P=0.044);行超声引导下微创治疗患者术后均无复发(0/41),行传统手术治疗患者术后复发率为13.33%(4/30),差异有统计学意义(P=0.028)。结论超声引导下微创治疗乳腺脓肿可缩短术后切口愈合及术腔完全闭合时间,瘢痕小,一次手术治疗成功率较高,术后复发率低,是临床治疗乳腺脓肿的较好方法 。     

超声引导穿刺在普通外科中的应用

目的　探讨高频超声在乳腺隐匿性病灶检出、超声引导穿刺定位切除活检和乳腺囊肿穿刺治疗的应用价值。同时介绍腹腔脓肿与积液的超声引导穿刺引流,超声引导PTCD。方法　1993年至今共检出乳腺隐匿性病灶250处,并在超声引导下作穿刺定位病灶切除术。对30处乳腺囊肿在超声引导下作穿刺治疗。5例腹腔脓肿、积液患者在超声引导下作穿刺引流。4例梗阻性黄疸患者在超声引导下行PTCD。结果　高频超声对乳腺隐匿性肿瘤诊断符合率为90%。同时检出9例隐匿性乳腺癌。5例腹腔脓肿、积液患者4例通过穿刺引流治愈。4例PTCD者3例引流成功。结论　超声为乳腺隐匿性病灶的检出、手术定位和囊肿穿刺治疗提供了有效手段。腹腔积液或脓肿超声下穿刺引流是一有效的非手术治疗,超声为PTCD提供了又一有效的引导方法。     

Ultrasound gray-scale pattern and guided aspiration puncture of abdominal abscesses

Various ultrasound gray-scale patterns of 45 consecutive abscesses were studied in 43 surgical and medical patients. Eleven abscess formations were unsuspected clinically, 27 had developed as a postoperative complication; 25 collections (55.6%) presented with an anechoic appearance, and 15 (33.3%) showed a mainly fluid pattern but contained a few nonreverberatory echoes. Five abscesses (11.1%) appeared with a complex solid-like pattern with large amounts of internal echoes. A total of 28 ultrasound guided diagnostic fine-needle aspirations of abscesses were performed on 26 patients without serious complications. All the aspirated samples yielded material sufficient for cytological or bacteriological examinations. Percutaneous fine-needle aspiration guided by sonography is recommended as a safe and useful diagnostic measure to confirm the nature of an ultrasonically displayed abdominal lesion suspected to be an abscess. Results from both sonography and confirmatory aspiration provide detailed topographic and diagnostic information for the choice of surgical or nonoperative management of abdominal abscess.