CT引导经皮穿刺置管引流治疗重症急性胰腺炎25例临床分析

目的探讨CT引导经皮穿刺置管引流(PCD)治疗重症急性胰腺炎合并胰腺坏死组织感染的临床应用价值。方法回顾性分析2013年1月至2015年1月安徽医科大学第二附属医院急诊外科应用PCD治疗25例重症胰腺炎合并胰腺坏死组织感染患者的临床资料。结果 25例患者共穿刺48次,穿刺成功率为100%;21例经PCD治疗成功,免于外科手术;3例经PCD治疗有效,减轻感染中毒症状延缓手术时机;1例引流无效死于多器官功能衰竭。结论 CT引导下PCD治疗重症胰腺炎合并胰腺坏死组织感染安全有效、创伤小,可避免或延缓传统外科手术。     

超声引导下经皮穿刺置管硬化肾囊肿的临床应用

目的 观察在超声引导下经皮穿刺置管引流、囊液引流后注射无水酒精硬化单纯性肾囊肿(囊肿长径均＞100 mm)的效果和安全性.方法 从2012年3月至2013年4月对21例较大肾囊肿患者在超声引导下经皮穿刺置入猪尾巴管并接引流袋,囊液引流干净后注射无水酒精治疗,观察术后对囊肿的治疗情况.结果 21例肾囊肿患者在超声引导下经皮穿刺置管硬化肾囊肿的治疗中获得成功,术后随访3～ 12个月,治愈率达95％,有效率达100％.结论超声引导下经皮穿刺置管硬化较大肾囊肿疗效明显,比以往单纯用穿刺针抽液及硬化治疗疗效显著.     

超声引导下经皮穿刺置管引流在胰腺假性囊肿中应用

目的 探讨超声引导下经皮穿刺置管引流在胰腺假性囊肿中的应用价值.方法 28例胰腺假性囊肿患者均行超声引导下经皮穿刺置管引流治疗.结果 28例均一次置管成功,治愈25例,有效3例,总有效率100％;置管时间15～92 d,4例更换引流管1次,1例更换引流管2次;引流量随时间递减.结论 超声引导下经皮穿刺置管引流治疗胰腺假性囊肿安全、有效,并发症少.     

超声引导下穿刺置管引流在重症患者盆腹腔积液治疗中的应用

目的探讨超声引导下穿刺置管引流术在重症患者盆腹腔积液治疗中的应用价值。方法选择重症患者盆腹腔积液80例,其中12例为重症急性胰腺炎患者,45例为外科手术后患者,11例为恶性肿瘤,6例为腹腔脓肿,6例为盆腔脓肿或其他。均在超声引导下行穿刺置管引流。结果所有患者穿刺置管过程顺利,引流量100～3 300 mL,引流时间5～15 d。80例患者中78例引流通畅,保守治疗临床治愈或好转,2例引流不彻底,改行外科手术治疗后治愈。未见气胸、血胸、腹腔内出血、穿刺部位感染。1例同时行胆囊造瘘术者术后寒战高热,对症治疗后好...     

超声内镜下经胃、十二指肠乳头引流治疗胰腺假性囊肿的效果评价*

目的探究超声内镜(EUS)下经胃或十二指肠乳头置管引流治疗胰腺假性囊肿(PPC)的临床疗效。方法选取2012年3月-2015年3月该院收治的100例PPC患者,按临床治疗指标对其中的80例进行EUS下经胃穿刺置管引流,20例行EUS下经十二指肠乳头穿刺置管引流。记录所有患者的治疗效果以及并发症的发生情况。结果 100例患者的手术中成功率为95.00%,其中囊肿完全消失率为84.00%。100例患者中共有10例发生术中出血,3例发生支架移位堵塞,另有7例术后出现囊肿内部感染,并发症的发生率为20.00%。结论对PPC患者进行EUS下经胃、十二指肠乳头穿刺置管引流治疗可以提高临床疗效,减少并发症,值得在临床上推广应用。     

CT引导穿刺引流联合经皮肾镜治疗急性重症胰腺炎合并胰周组织坏死的疗效

【目的】探析CT引导穿刺引流联合经皮肾镜微创治疗急性重症胰腺炎（ASP）合并胰周组织坏死的效果。【方法】取2011年2月至2013年11月本院收治的20例确诊为ASP合并胰周组织坏死患者,其中4例为高脂血症所致胰腺炎,胆源性胰腺炎16例,为初治患者。所有患者入院因脾脏、胃肠道、胆道等遮挡,无适当的穿刺路径,超声穿刺置管引流改行CT引导下穿刺引流联合经皮肾镜治疗。【结果】①患者CT引导下穿刺抽液细菌学检查为肠球菌、大肠杆菌、假单胞菌属、变形杆菌、霉菌单一细菌感染或两种以上细菌混合感染。②C T引导经皮穿刺引流成功率100％,16例经皮肾镜清除胰腺坏死感染组织1次后,炎症感染症状迅速控制,1例术中解剖结构粘连,转开腹手术,2例因术中坏死组织清除不彻底行二次手术,1例高脂血症性胰腺炎外院转入,术后并发多功能脏器衰竭。③15例患者术后5～9 d好转后经治愈出院,4例术后14～17 d住院带管出院,1例并发多脏器功能衰竭治疗4周后病情好转。无死亡病例,所有患者平均住院时间（13．5±1．6）d。【结论】对ASP合并胰周组织坏死者,在临床生命体征控制稳定后,结合临床传统的内外科治疗手段,采取CT引导下引流经皮肾镜微创技术,可最大程度降低手术对机体的创伤,清除坏死感染组织,促进病情好转,取得较好的疗效。     

超声引导下经皮胆囊穿刺置管引流术治疗高龄急性胆囊炎患者围术期管理

目的探讨超声引导下经皮胆囊穿刺置管引流术治疗高龄急性胆囊炎患者围术期的管理。方法分析2012-01—2014-05河北联合大学附属医院普外科超声引导下经皮胆囊穿刺置管引流治疗86例高龄急性胆囊炎患者,通过围术期管理改善临床症状,并对改善疗效进行统计学分析。结果 86例患者导管置入成功率100%,超声引导下经皮胆囊穿刺置管引流术24~48 h腹痛缓解97.67%(84/86),24 h心率、体温下降90.70%(78/86),24~72 h实验室指标血白细胞、胆红素明显下降或恢复正常96.51%(83/86)。术后导管滑脱3例(3/86,3.49%),引流液微生物培养阳性率31.40%(27/86)。术后24例急性胆囊炎患者治愈出院,62例胆囊结石患者行Ⅱ期LC/ERCP+EST 43例,行开腹胆囊摘除胆总管切开取石术11例,因高龄带管出院3例,现仍置管引流,拟行择期手术5例。结论超声引导下经皮胆囊穿刺置管引流术对于不宜急诊手术的高龄患者是一种应急措施,加强围术期管理为其后续手术创造条件。     

CT引导下经皮穿刺置管持续引流治疗咽旁脓肿病人的护理

[目的]总结CT引导下经皮穿刺置管持续引流治疗咽旁脓肿的护理。[方法]对10例咽旁脓肿病人行CT引导下经皮穿刺置管持续引流治疗,同时加强护理。[结果]10例病人均一次性穿刺置管成功,无需手术治疗;随访1个月均愈合良好,无严重并发症发生。[结论]加强CT引导下经皮穿刺置管持续引流治疗咽旁脓肿的护理有利于预后。     

超声引导下经皮穿刺置管引流治疗胰腺假性囊肿16例分析

目的：探讨胰腺假性囊肿超声引导下经皮穿刺置管引流治疗的临床价值。方法：采用超声引导经皮穿刺治疗胰腺假性囊肿16例,其中单纯抽液1例,置管引流15例。结果：16例穿刺16次,共放入引流管15根,1例因囊腔与主胰管相通,改行开腹囊肿空肠Roux-Y吻合术,引流时间2周~6个月,临床治愈率96%,未见复发,无并发症。结论：超声引导下经皮穿刺置管引流治疗胰腺假性囊肿具有创伤小、疗效好、并发症少、可重复的优点,为临床提供了一种简便易行、疗效显著的微创治疗途径,可作为胰腺假性囊肿的首选治疗方法。     

CT引导下经皮穿刺肝脓肿置管引流术临床应用

目的:探讨CT引导下经皮穿刺肝脓肿置管引流术在肝脓肿治疗中的应用。方法:对临床和影像学确诊的27例较大的肝脓肿患者通过CT扫描确定脓肿的位置、穿刺途径、角度及深度后行经皮穿刺肝脓肿置管引流术。结果:本组27例患者均1次穿刺置管引流成功,效果满意,治愈率96.3%,无明显并发症。结论:CT引导下经皮穿刺肝脓肿置管引流术定位精确,安全简便,是治疗肝脓肿的首选方法。     

开放式双套管持续低负压引流治疗肠瘘合并腹腔感染(附29例报告)

目的探讨开放式双套管持续低负压引流在肠瘘合并腹腔感染治疗中的方法和效果。方法回顾性分析2006年6月至2011年12月期间在我科住院治疗29例肠瘘合并腹腔感染患者的临床资料,29例患者均采用了开放式双套管持续低负压引流。结果 24例患者直接更换开放式双套管,并予以持续低负压冲洗引流后腹腔感染得到控制,瘘口自行愈合。5例患者因经引流3~5天后仍出现高热、弥漫性腹膜炎症状无明显好转而再次手术治疗,术中重新放置开放式双套管,术后行持续冲洗引流,其中3例治愈,1例患者因继发多器官功能脏器衰竭而死亡,1例自动出院。结论开放式双套管持续低负压引流技术治疗肠瘘合并腹腔感染具有显著的疗效。明显降低了再次开腹手术率和死亡率。     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

Endoscopic ultrasonography-guided drainage of intra-abdominal fluid collection after liver transplantation: a case series of six patients

Intra-abdominal fluid collection associated with infection is a major complication after liver transplantation (LT). However, post-LT recipients are at high risk for requiring various interventions and surgeries, due to their poor, immunosuppressed conditions. We herein describe six patients with symptomatic or growing intra-abdominal fluid collection after LT who underwent endoscopic ultrasonography (EUS)-guided drainage. There were five males and one female, and the median age was 47 years (24–60 years). All procedures were technically and clinically successful in all patients. The median number of endoscopic sessions was 2.5 (1–4 sessions) until resolution. Procedure-related adverse events occurred in two patients and included peritonitis, bleeding, and stent migration, which improved conservatively or endoscopically. During the median follow-up period of 63 months (17–110 months), recurrence occurred in one patient. EUS-guided drainage is an effective and safe treatment for intra-abdominal fluid collection even in post-LT recipients.     

微通道穿刺引流联合输尿管镜内置双J管治疗特发性肾包膜下积液的疗效观察

目的探讨特发性肾包膜下积液患者行肾包膜下微通道穿刺引流联合输尿管镜内置双J管的疗效。方法回顾性分析16例特发性肾包膜下积液患者的临床资料,女12例,男4例,平均年龄(40.00±4.00)岁,单侧10例,双侧6例,均经B超、静脉尿路造影术、CT及穿刺液检查明确诊断,并采用局麻B超定位下肾包膜下微通道穿刺置管引流联合输尿管镜内置双J管。结果特发性肾包膜下积液成分与单纯性肾囊肿成分相似。所有患者均手术顺利,无并发症发生,平均随访(36.80±14.20)个月,无1例肾包膜下积液复发。结论特发性肾包膜下积液为临床罕见疾病,目前病因和病理机制尚不明确,治疗上主要以对症处理为主,局麻B超定位下肾包膜下微通道穿刺置管引流联合输尿管镜内置双J管术疗效确切,值得临床推广。     

腰大池引流治疗脊髓空洞症术后皮下囊性积液的效果

目的分析腰大池置管引流脑脊液治疗脊髓空洞症术后皮下囊性积液的疗效。方法回顾性分析我院自2010年7月~2014年7月间收治的28例脊髓空洞症术后皮下囊性积液的患者临床资料,其中19例采用腰穿置管腰大池引流及枕部加压包扎治疗,9例患者采用多次腰穿及枕部加压包扎治疗。结果腰大池引流治疗组皮下囊性积液消失时间明显短于腰穿组（P < 0.05）,两组并发症的比较差别无统计学意义（P>0.05）。结论腰大池引流及枕部加压包扎治疗脊髓空洞症术后皮下囊性积液临床疗效优于传统的腰穿及枕部加压包扎,具有操作简便、创伤小、并发症少等优点,同时避免了手术修补硬膜带来的二次损伤。      

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.     

胰腺损伤的诊断与治疗（附21例报告）

目的探讨胰腺损伤的诊断及治疗方法。方法分析1995年1月～2005年12月间收治的21例胰腺损伤的诊断与治疗情况。结果按美国创伤外科学会（AAST）胰腺损伤分级法分级：Ⅰ级4例，Ⅱ级5例，Ⅲ级7例，Ⅳ级3例，Ⅴ级2例。本组均手术治疗，术后发生假性胰腺囊肿2例，胰瘘3例，腹腔脓肿1例，肺部感染2例，切口感染3例；治愈19例，死亡2例。结论胰腺损伤早期诊断是治疗的关键。诊断主要依靠外伤史，CT检查及腹腔穿刺液淀粉酶检查；剖腹探查是诊断的又一重要手段，术中仔细探查十分重要。治疗以清创、止血、引流、保存胰腺功能为基本原则，根据损伤的程度采用不同的手术方式。     

侧脑室引流联合双针腰穿脑脊液置换治疗脑室出血

目的:比较侧脑室引流联合双针腰穿脑脊液置换治疗和单纯侧脑室引流治疗脑室出血的疗效。方法:94例脑室出血患者分别采用侧脑室引流加尿激酶灌注联合双针腰穿脑脊液置换治疗(治疗组,46例)或侧脑室穿刺引流加尿激酶灌注治疗(对照组,48例),比较二组的存活率、死亡率和脑积水发生率。结果:治疗组死亡6例(13%),而对照组死亡15例(31%),二者的疗效差异有统计学意义(P<0.05)。术后随访半年,治疗组中并发交通性脑积水1例,对照组则为7例。结论:侧脑室引流联合双针腰穿脑脊液置换治疗脑室出血的疗效优于单纯侧脑室引流。     

Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment

BACKGROUND AND STUDY AIMS: Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy. PATIENTS AND METHODS: All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients' charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002. RESULTS: A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97 % and the mortality rate was 1 %. Complications occurred in 31 patients (34 %), eight of which (9 %) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11 %) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5 %) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71 %). CONCLUSIONS: Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.     

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.