超声内镜引导下经胃引流治疗早期胰腺假性囊肿23例

目的 探讨超声内镜引导下经胃引流治疗早期胰腺假性囊肿的疗效.方法 回顾性分析2003至2008年在超声内镜引导下早期经胃穿刺置管引流进行治疗的23例巨大胰腺假性囊肿患者的临床资料.结果 假性囊肿位于胰头部3例,胰体部11例,胰尾部9例,囊肿平均直径11 cm(8～18 cm),均为单发囊性,所有病例在超声内镜引导下经胃引流治疗胰腺假性囊肿,假性囊肿发现至穿刺手术间隔17～65d,平均31 d.2例术后发生囊肿感染,1例改用外引流,另1例改用手术内引流治疗治愈;3例出现消化道出血,保守治疗后治愈.2～3个月后CT复查,6例患者假性囊肿完全消失,余15例患者囊肿明显缩小,所有患者腹胀、腹痛症状缓解.随访1年,无溃疡、出血、囊腔感染等并发症发生.结论 超声引导下早期经胃穿刺置管引流治疗胰腺假性囊肿是安全、有效的.     

胰腺囊性疾病破裂的诊断与治疗(附20例临床病例分析)

目的探讨胰腺囊性疾病破裂的诊断与治疗。方法回顾性分析2011年6月至2015年12月期间哈尔滨医科大学附属第一医院胰胆外科收治的20例胰腺囊性疾病破裂患者的临床资料,其中胰腺假性囊肿15例,胰腺囊性肿瘤5例。结果 5例胰腺囊性肿瘤患者均行手术切除,其中2例行胰十二指肠切除术,3例行胰体尾脾切除术。15例胰腺假性囊肿患者中,行超声引导下胰腺假性囊肿穿刺置管引流2例;内镜下胰管内支架引流2例;内镜下胰管内支架引流联合超声引导下胰腺假性囊肿穿刺置管引流2例;手术治疗9例,其中假性囊肿外引流1例,假性囊肿内引流8例(胰腺假性囊肿空肠吻合5例,胰腺假性囊肿胃吻合3例)。术后发生胰瘘3例(A级2例,B级1例),胃排空障碍1例,肺部感染2例,腹腔积液1例。随访3个月至5年,平均25.6个月,1例胰腺假性囊肿患者行内镜下胰管内支架引流术后假性囊肿复发,还有1例胰腺假性囊肿患者行假性囊肿内引流术后复发,2例复发患者均经非手术治疗后症状好转,痊愈出院。结论正确地鉴别胰腺囊性肿瘤与胰腺假性囊肿是胰腺囊性疾病破裂治疗方式选择的前提。胰腺囊性疾病破裂的治疗较常规胰腺囊性疾病的治疗急迫,治疗方式的选择至关重要,应根据患者具体情况制定出个体化治疗方案,使患者最大程度获益。     

超声引导经皮穿刺在胰腺假性囊肿诊断和治疗中的应用

目的：探讨超声经导下经皮穿刺抽液或置管引流在胰腺假性囊肿诊断和治疗的应用价值。方法：１９９３～１９９７年在超声经导下经皮穿刺治疗１２例胰腺假性囊肿，穿刺抽出的囊液，腹水，胸水常规测定淀粉酶含量，单纯穿刺抽液５例，置管引流７例，囊腔内注射无水酒精治疗２例，结果：１２例均痊愈，随访４～１８个月无复发。结论：超声引导下经皮穿刺抽液或置管引流是胰腺假性囊肿合理的治疗方法之一，常规测定囊液，腹水，胸水的淀粉     

彩超引导下经皮穿刺置管治疗胰腺假性囊肿30例临床体会

探讨彩超引导下穿刺置管治疗胰腺假性囊肿的疗效。回顾性分析30例胰腺假性囊肿患者彩超引导下穿刺置管治疗临床资料,并与手术内引流进行比较。30例患者经置管引流10~100 d,全部临床治愈,随访3~12个月,无复发,较手术内引流组创伤小,并发症少,但恢复时间较长。彩超引导下穿刺置管治疗胰腺假性囊肿简单、经济、有效,是治疗胰腺假性囊肿的首选方法。     

超声内镜引导下穿刺引流治疗胰腺假性囊肿

目的探讨超声内镜引导下经胃肠壁穿刺置管引流治疗胰腺假性囊肿的疗效及并发症。方法选择2004年8月至2011年3月胰腺假性囊肿患者28例,首先使用线阵型超声内镜扫查,明确病变部位后选择合适穿刺点,导丝沿穿刺针道进入囊肿,沿导丝放置双猪尾硅胶支架1～3支。术后定期随访,囊肿消失后拔除支架。结果本组28例患者,穿刺引流成功25例,成功率为89．3％,其中经胃19例,经十二指肠6例。发生并发症3例,支架移位、出血、感染各1例。随访8—34个月,19例假性囊肿完全消失,6例腹痛症状消失、囊肿明显缩小、但持续存在2年以上,所有患者均未见假性囊肿复发。结论超声内镜引导下经胃肠壁穿刺置管引流术是治疗胰腺假性囊肿的较好方法之一,其疗效确切,并发症少。     

超声引导下微创治疗急性胰腺假性囊肿

目的探讨应用微创方法治疗急性胰腺假性囊肿的优势及最佳时机选择。方法在彩色多普勒超声引导下对34例急性胰腺假性囊肿行穿刺抽吸术及置管引流术;并于术后定期复查,以观察评价治疗效果。结果对8例囊肿直径6cm者,采取穿刺抽液术治疗,穿刺1～4次/例,平均2.4次/例,2～4周治愈,平均2.6周。26例直径≥6cm者,采取穿刺置管引流术,引流时间16～45d,平均31.8d;住院时间12～25d,平均18.6d。34例患者中共有32例接受随访,其中26例随访半年无复发;有6例复发,均为囊肿直径≥6cm者,经再次穿刺置管引流术后治愈。结论超声引导经皮穿刺抽吸术或置管引流术是治疗急性胰腺假性囊肿的首选方法,方法简便,疗效确切,具有创伤小、并发症少、可重复操作等优点;在治疗时机上,只要胰腺假性囊肿诊断成立,无论选择穿刺抽吸术或置管引流术,均以尽早治疗为原则。     

超声引导经皮穿刺置管引流术在重症急性胰腺炎中的应用(附35例报道)

目的探讨超声引导经皮穿刺置管引流术在重症急性胰腺炎(SAP)治疗中的应用价值。方法对我院2001年1月至2009年12月期间收治的35例腹腔渗液较多及合并胰腺周围积液、假性胰腺囊肿及脓肿的SAP患者采用了超声引导经皮穿刺置管引流术,观察其疗效。结果 35例患者,置管引流45例次,置管成功率为100%。4例(11.4%)中转开腹手术,31例(88.6%)置管能有效引流。2例(5.7%)穿刺后并发少量出血。结论选择性应用超声引导经皮穿刺置管引流术对于腹腔积液较多及合并局部并发症的SAP患者,是一种有效的治疗手段。     

胰腺囊肿的诊断与治疗体会

目的探讨胰腺囊肿的诊断与治疗方法，减少对胰腺囊性疾病的误诊和误治。方法对1998年-2006年我院收治的44例胰腺囊肿患者的临床资料进行回顾性分析。结果假性胰腺囊肿占36例，占81，8％（36／44）；囊性肿瘤6例，占13．6％（6／44）；潴留性囊肿2例。6例假性胰腺囊肿经保守治疗后消退，8例行经皮穿刺引流，其余均行手术引流或切除术。结论假性胰腺囊肿占全部囊肿大多数且多由急性胰腺炎所致。在诊断假性囊肿时应首先排除囊性肿瘤，术前ERCP检查和术中组织冰冻切片对胰腺囊肿的鉴别诊断和选择合理的治疗方案至关重要。对已诊断的囊性肿瘤，无论良、恶性应尽可能作根治性切除术。     

超声引导下经皮穿刺硬化治疗子宫内膜异位性囊肿的临床应用

目的:探讨超声引导下经皮穿刺硬化治疗子宫内膜异位性囊肿的临床应用价值.方法:回顾性分析接受超声引导下经皮穿刺硬化治疗的113例子宫内膜异位性囊肿患者资料,观察超声引导下经皮穿刺硬化治疗子宫内膜异位性囊肿的方法及疗效.结果:113例患者120个囊肿中治愈113个,囊肿缩小7个,无无效病例,首次治愈率94.17%,总有效率100%.结论:超声引导下经皮穿刺硬化治疗可作为子宫内膜异位性囊肿的首选治疗方法.     

肠内延伸型胆管支架引流治疗胰腺假性囊肿7例

目的 探讨超声内镜(endoscopic ultrasound,EUS)经胃穿刺应用肠内延伸型胆管支架引流治疗胰腺假性囊肿(pancreatic pseudocyst,PPC)的效果和安全性.方法 回顾性分析2019年12月～2021年3月我科应用肠内延伸型胆管支架,在EUS引导下经胃穿刺引流治疗7例PPC.结果 7例...     

A new diagnostic approach to pancreatic pseudocyst fine-needle puncture: three-dimensional sonography

Background/Purpose We evaluated the usefulness of three-dimensional (3D) sonography in percutaneous fine-needle pancreatic pseudocyst puncture.Methods We examined 52 patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional (2D) ultrasonography findings. The decision to qualify certain patients for percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of 2D and 3D scan results. Spiral computed tomography was done when the presence of connections between pseudocyst and pancreatic duct was suspected. In these cases diagnosis was confirmed in operative procedures. 3D sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection.Results Pancreatic pseudocysts were diagnosed in all 52 cases; 48 patients underwent percutaneous fine-needle biopsies.Conclusions 3D presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical 2D ultrasound scans. The use of subtraction in 3D scans of blood vessels increases the safety in performing biopsies. We have shown that 3D sonography collects extremely useful information about the status of the pseudocyst structure, and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis should help us change the inclusion criteria for guided biopsies.     

非胰腺手术后胰腺假性囊肿的治疗

目的探讨非胰腺手术后胰腺假性囊肿的治疗方法。方法对近11年来治疗的28例非胰腺手术后胰腺假性囊肿进行回顾性临床分析。结果保守治疗4例。B超引导下经皮多次穿刺10例(其中穿刺后置管外引流3例)。手术行外引流6例,内引流8例。1例外引流无效后,改行内引流。28例均痊愈出院。结论手术后胰腺假性囊肿应采用个体化的治疗原则,早期应采取保守治疗、穿刺抽液或外引流,内引流可作为治疗的最后选择。     

Prostatic abscesses. A review]

We review the literature to the diagnosis and therapeutic aspect of prostatic abscess. The prostatic abscess having become an uncommon disease. The diagnosis of prostatic abscess has been nearly made by transrectal ultrasound and computed tomography scan. The best diagnostic method is considered to be the transrectal ultrasound. The choice therapy was intravenous antibiotic, and drainage by ultrasound guided transperineal percutaneous puncture.     

B超引导下肾囊肿穿刺要点

目的 探讨彩色多普勒超声引导下肾囊肿穿刺要点.方法 对126例原发性肾囊肿患者进行了彩色多普勒超声引导经皮穿刺治疗.结果 所有患者均一次性穿刺成功,成功率100％,其中肾盂旁囊肿26例,随访0.5～2年,121个囊肿均治愈,治愈率96.03％,均未出现出血与感染等并发症.结论 彩色多普勒超声引导下经皮穿刺治疗肾囊肿,成功率和治愈率高,并发症少.     

Experience of combined endoscopic percutaneous stenting with ultrasound guidance for drainage of pancreatic pseudocycts

The therapeutic options for treatment of pancreatic pseudocysts are numerous. We report our experience of combined endoscopic and ultrasound guided percutaneous stenting for pancreatic pseudocysts. Data were prospectively collected for 20 consecutive patients. All patients had undergone a standard technique of combined endoscopic and ultrasound guided percutaneous placement of double J stents, between a pancreatic pseudocyst and the stomach. Patients age ranged between 25 and 84 years. Thirteen of the pseudocysts were due to acute pancreatitis and 7 were due to chronic pancreatitis. The duration of the combined procedure was mean 50 min (range 30-95 min). The length of hospital stay was mean 5 days (range 2-77 days. Only two patients suffered postoperative complications; one was re-admitted 2 weeks following stenting with acute cholecystitis, the other suffering a perforated duodenal ulcer 3 weeks after stenting. There were two failures early in the series, both due to stent migration, these stents were of a small size, (4.7 French). Following this the stent size was increased to at least 7 French, no further failures occurred. There was no operative mortality for the series. Follow-up ranged between 6 months and 5 years. We conclude that a combined percutaneous and endoscopic cyst-gastrostomy stent is a safe and effective treatment for patients with suitably placed pseudocysts.     

Needle aspiration in the treatment of pancreatic pseudocyst in childhood.

The technique of percutaneous needle aspiration of pancreatic pseudocyst using ultrasound imaging as a guide is reviewed. A modification of this technique has been used in a child with a post-traumatic pancreatic pseudocyst.     

Percutaneous technique in the diagnostics and therapy of renal diseases

Based on the literature and of their own experience, authors deal with the possibility of the percutaneous approach of renal diseases. Of the diagnostic and therapeutic interventions, they report their experience regarding percutaneous nephrolithotomic investigative methods employed in the differential diagnosis of renal masses. During a period of one-and-a-half years, percutaneous nephrostomy was performed in 130 cases, of them in 64 for removing stones. In 48 cases of renal tumours revealed to be cystous structures by ultrasonography, puncture controlled by ultrasound was made. Based on the cytological and chemical analyses of the samples obtained by puncture, exploration was made in 6 cases for suspicion of malignancy. The requirements of the application of the percutaneous technique is discussed.     

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法治疗单纯性肾囊肿

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法治疗单纯性肾囊肿的治疗方法 和临床应用价值.方法 对58例原发性肾囊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无水乙醇硬化法治疗.结果所有患者均一次性穿刺成功,成功率100%,术后均放置中心静脉导管.经引流管共注射无水乙...     

CT联合超声引导精准经皮肝穿刺技术在肝VIII段病灶治疗中的应用

目的 探讨精准经皮肝穿刺技术用于肝VIII段小肝癌和脓肿治疗中应用的安全性和可行性。方法 回顾性分析2017年1月至2021年5月期间新疆维吾尔自治区第三人民医院行肝穿刺治疗的肝VIII段病灶患者63例的临床资料。根据肝穿刺引导方法不同分为2组：CT+超声组（30例）,接受局麻或不插管的静脉麻醉下CT联合超声引导的经皮肝穿刺置管引流/射频消融治疗;腔镜+超声组（33例）,接受插管的静脉麻醉下腹腔镜联合镜下超声引导的肝穿刺置管引流/射频消融治疗。对比分析肝穿刺治疗围手术期相关指标、手术并发症发生情况、手术后患者手术和疼痛的接受程度。结果 CT+超声组较腔镜+超声组的穿刺时间短[（39.33±6.79）min vs （50.90±5.51）min]、下床时间早[（11.07±3.44）h vs （15.73±3.25）h]、术后胃肠功能恢复时间早[（8.23±1.43）h vs （14.79±3.34）h],差异均具有统计学意义（P<0.05）;两组穿刺次数[（1.13±0.35）次 vs （1.09±0.29）次]、穿刺成功率[93.3%（28/30） vs 100.0%（33/33）]无统计学差异（P>0.05）。两组肝脓肿穿刺置管（分别为7例和9例）均成功,恶性肿瘤（分别为23例和24例）消融后残留率均为零。CT+超声组手术并发症总体发生率与腔镜+超声组[26.7%（8/30） vs 27.3%（9/33）,χ²=0.003,P=0.118]差异无统计学意义（P>0.05）;手术疼痛接受程度高于腔镜+超声组[96.7%（29/30） vs 75.7%（25/33）],差异具有统计学意义（P<0.05）。结论 局麻或不插管的静脉麻醉下CT联合超声引导的精准经皮肝穿刺技术作为肝VIII段小肝癌和脓肿的辅助治疗技术安全可行,可用于≤3.5 cm的病灶穿刺,可以获得与全麻下腹腔镜联合镜下超声引导的肝穿刺技术治相近的治疗效果,且手术时间更短,手术创伤更小、接受程度更高。     

介入超声联合胆道镜微创化治疗胰周脓肿

目的探讨介入超声联合胆道镜建立治疗胰周脓肿微创化的模式。方法对52例确诊胰周脓肿患者实施介入超声穿刺置管引流,而后扩张窦道,胆道镜清创患者的临床资料进行回顾性分析。结果全组52例患者,50例经此方法治愈,治愈率96.2%,2例因穿刺引流效果欠佳改行开腹手术引流。50例患者平均治愈时间73 d,其中1例并发肠外瘘,2例并发出血,均经非手术治愈。所有患者随访3个月至1年以上,无胰周坏死组织残留。结论介入超声联合胆道镜治疗胰周脓肿是一种安全、有效的治疗方法,可予推广应用。