超声引导介入诊治肝脓肿的临床价值研究

目的：探讨B超引导下介入治疗肝脓肿的临床应用价值。方法：对147例门诊和住院肝脓肿患者实施B超引导下经皮肝穿刺抽吸或置管药物冲洗引流术，其中108例为单纯穿刺抽脓冲洗，39例为置管引流冲洗。结果：本组115例经超声诊断为肝脓肿，23例经CT诊断为肝脓肿，9例CT诊断为可疑的肝脓肿。147例均在超声引导下行经皮肿块穿刺抽吸术后证实为肝脓肿，经1～4次抽吸及注药治疗后，临床症状消失，复查示脓腔小于20mm，随访6个月均痊愈。结论：超声引导下穿刺诊治肝脓肿是一种安全、简便、经济、高效的方法，可作为临床治疗细菌性肝脓肿的首选方法，值得推广。     

比较CT与超声在导引腹部囊肿经皮穿刺硬化治疗中的作用

目的比较CT与超声在腹部囊肿经皮穿刺抽液并硬化治疗中的导引作用。方法CT导引下穿刺腹部囊肿抽液硬化治疗38例,超声导引下45例。结果CT导引下共穿刺46个囊肿,穿刺次数83次,硬化治疗失败6例;超声导引下共穿刺71个囊肿,穿刺次数87次,硬化治疗失败1例。超声导引下行经皮穿刺腹部囊肿抽液并硬化治疗每个囊肿平均穿刺次数及硬化治疗失败例数均显著少于CT导引。结论经皮穿刺硬化治疗腹部囊肿术中,超声导引较CT导引具有更多的优势。     

超声引导下穿刺治疗盆腔内膜异位囊肿的疗效分析

目的探讨超声引导下穿刺治疗盆腔内膜异位囊肿的疗效及临床应用价值。方法术前经腹部或阴道超声明确诊断为盆腔内膜异位囊肿的102例112个囊肿，在超声引导下进行1次或多次的穿刺抽吸及无水酒精硬化治疗术，并跟踪随访一年。结果所有随访的102例患者112个囊肿中，囊肿直径小于6cm的60个一次治疗后均彻底消失：囊肿直径在6～8cm的40个，其中35个一次治疗后囊肿消失，5个经多次重复治疗后囊肿消失；直径大于8cm的囊肿12个。其中4个一次治疗后囊肿消失．6个经多次重复治疗后囊肿消失，2个经多次重复治疗后囊肿明显缩小。结论超声引导下盆腔内膜异位囊肿的穿刺抽吸及硬化治疗方法简便、实用、安全，囊肿直径小于8cm的穿刺硬化治疗疗效明显，值得临床推广。     

B超引导穿刺介入治疗盆腔囊肿的疗效分析

目的 探讨B超引导下穿刺药物介入治疗盆腔囊肿的疗效。方法 对23例有腹部手术史及不愿接受开腹手术的盆腔囊肿患者，采用B超监测、定位，抽吸盆腔囊肿内容物，冲洗囊腔，注入无水酒精、抗生素、地塞米松、糜蛋白酶的治疗方法。并定期复查。观察其疗效。结果 对盆腔囊肿在B超引导下穿刺行药物介入治疗，可达到与开腹手术切除囊肿基本相同的治疗效果。结论 B超引导下穿刺药物介入治疗盆腔囊肿探作简单，创伤小，成功率高，无并发症，是一种安全可靠的治疗方法。     

B超引导穿刺硬化治疗单纯性肾囊肿42例报告

目的:观察超声引导下细针穿刺抽吸及注射无水酒精硬化治疗肾囊肿的临床疗效。方法:在B超引导下对42例患者45个肾囊肿抽液后注入无水酒精治疗,术后定期复查。结果:本组42例(45个囊肿)治疗后定期随访,术后6个月复查B超,囊肿消失18个(40.0%),14个(31.1%)囊肿直径小于穿刺前直径的1/3,9个(20.0%)囊肿直径为穿刺前直径的1/3～2/3,4个(8.9%)囊肿直径大于穿刺前直径2/3,无1例囊肿较穿刺前增大。结论:B超引导下细针穿刺抽吸及注射无水酒精硬化治疗肾囊肿定位准确,术中创伤小,术后并发症少,疗效可靠。     

B超、CT联合诊治胰腺周围脓肿

目的:探讨联合应用B超、CT在胰腺周围脓肿诊断和治疗中的价值.方法:36例急性胰腺炎患者应用B超、CT监测并确诊胰腺周围脓肿;并在B超、CT联合引导下穿刺置管引流和胆管镜下清刨治疗.结果:胰腺周围脓肿早期诊断率100%,其中8例八院时确诊,另28倒治疗中明确诊断.36例患者均在B超、CT引导下经穿刺置管和胆管镜F清创治疗;治愈33例,2例并发胰腺假性囊肿者后期行囊肿空肠吻合术,1例因多器官功能衰竭死亡.术后并发出血2例、肠瘘3例,均经对症处理后治愈.结论:B超、CT诊断胰腺周围脓肿方法简单,早期诊断率高;B超、CT联合引导下穿刺置管引流以及胆管镜下清创治疗胰腺周围脓肿安全,有效.     

超声引导下穿刺治疗盆腔囊肿的应用价值

目的探讨彩色多普勒超声引导下进行盆腔囊肿穿刺的治疗效果。方法对73例盆腔囊肿患者行经腹部或经阴道超声引导下囊肿穿刺,抽液后部分行无水乙醇硬化囊壁治疗,所有囊液均送病理检查。结果 73例患者均一次性穿刺成功,无严重并发症发生。1例患者11个月后复发,另1例患者14个月后复发,均经二次穿刺治疗后痊愈;其余患者未见复发。结论彩色多普勒超声引导下经腹或经阴道穿刺抽液及无水乙醇硬化囊壁治疗盆腔囊肿是一种微创、简便易行、疗效肯定的治疗方法。     

经阴道超声引导穿刺治疗盆腔囊肿

目的 :探索穿刺治疗盆腔囊肿的方法及适应症。方法 :对 3 0例临床和B超确诊为盆腔囊肿的病人 ,在超声引导和监视下 ,经阴道穿刺抽液 ,依据囊液细胞学检验结果注入相应的药物 (抗菌、抗结核 )或硬化剂。结果 :治疗 3 0例 ,2 3例一次穿刺治愈 ,1例两次穿刺治愈 (治愈率 80 % ) ,3例两次穿刺后明显缩小 (有效率 90 % )。平均随访 3年 10个月未复发。结论 :超声引导和监视下穿刺治疗盆腔囊肿具有简便易行、微创、安全、实用、疗效可靠等优点。不失为治疗盆腔囊肿的最佳方法之一     

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.     

卵巢囊肿的CT介入反复冲洗硬化治疗

目的 评价CT介入反复冲洗硬化治疗卵巢囊肿的疗效。方法 50例共56个囊肿采用CT引导下经皮穿刺硬化治疗。所有囊肿均在抽吸囊液后注入99．7％无水乙醇反复冲洗2～4次。结果 本组所有病例均经B超随访3～6个月，除4例5个囊肿腔缩小2／3外其他囊腔均消失或基本消失，治愈率为92％，总有效率100％。结论 CT引导下经皮穿刺抽吸反复冲洗硬化治疗卵巢囊肿具有高效、安全、创伤小的特点，可以作为良性卵巢囊肿的首选方法。     

计算机断层摄影引导下经皮细菌性肝脓肿穿刺置管引流

  目的  评价计算机断层摄影(computed tomography, CT)引导下经皮穿刺引流治疗细菌性肝脓肿的安全性和有效性。  方法  回顾性分析2004年1月至2010年12月, 54例在本院行CT引导下细菌性肝脓肿穿刺置管引流患者的临床及影像学资料。  结果  54例肝脓肿患者中37例为单一病灶, 17例为多发病灶; 脓肿平均最大径为(10.5±5.6)cm; 穿刺技术成功率为100%, 无严重并发症发生, 全部患者穿刺引流治疗后症状得到改善。41例患者在住院期间拔除外引流管, 平均置管时间(20.6±7.8)d; 另13例患者症状好转后, 带管出院。  结论  CT引导下经皮穿刺引流治疗细菌性肝脓肿安全而有效。     

CT引导下经皮肺穿刺肺小结节的临床价值(附45例报告)

目的探讨肺部直径≤2cm结节灶在CT引导经皮肺穿刺活检的准确性、并发症及诊断价值。方法回顾性分析2005年3月～2008年5月期间行CT引导下经皮肺穿刺活检并经手术病理、临床治疗或随访观察证实且资料完整的孤立性肺结节病例45例,分析其敏感性、特异性、准确性及并发症。结果 45例孤立性小肺结节病灶中经手术病理、临床治疗或随访观察证实为恶性肿瘤者28例,良性病变者17例;而CT引导下经皮肺穿刺活检诊断为恶性肿瘤者22例,良性病变者23例。对恶性肿瘤的诊断敏感性78.6%(22/28),特异性100%(22/22),阳性预测值100%(22/22);对良性病变的诊断特异性100%(17/17),阴性预测值73.9%(17/23);总的诊断准确率86.7%(39/45)。并发症:气胸5例(11.1%),肺出血2例(4.4%),咯血2例(4.4%)。结论直径≤2cm的肺部结节行CT引导下经皮肺穿刺活检的准确率较高而并发症较低,可作为肺内孤立性小结节灶定性诊断的首选方法,值得推广。     

Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach

Infected pelvic fluid collections are relatively common particularly after abdominal or pelvic surgery or in patients suffering from benign intestinal disease such as diverticulitis, appendicitis, or Crohn's disease. Historically the treatment of pelvic abscess has been either laparotomy with lavage or blind surgical incision and drainage through the rectal or vaginal wall. More recently, computed tomography and ultrasound-guided percutaneous drainage has become the procedure of choice, when feasible, for the treatment of pelvic abscess. However, many deep pelvic collections are not amenable to percutaneous technique. Transrectal or transvaginal ultrasound-guided abscess drainage is a safe and effective method used in the treatment of deep pelvic abscesses. The purpose of this article is to review the techniques, patient selection, pre- and post-procedural care, and monitoring aspects of transrectal or transvaginal ultrasound-guided drainage.     

Percutaneous, computed tomography-guided drainage of deep pelvic abscesses via a transgluteal approach: a report on 30 cases and a review of the literature

Aim

Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature.

Materials and methods

We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient’s short-term treatment outcome.

Results

From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14–88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn’s disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3–33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage.

Conclusion

When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).     

超声引导穿刺无水乙醇硬化治疗腹盆腔脏器囊肿509例临床分析

目的探讨超声引导无水乙醇硬化治疗腹盆腔脏器囊肿的临床效果及安全性。方法超声引导下对509例患者的腹盆腔脏器囊肿穿刺行无水乙醇硬化治疗。结果509例中超声检出526个囊肿（肝囊肿169例、肾囊肿328例、脾囊肿2例、胰囊肿4例、卵巢囊肿6例）。囊肿大小2．5cm×3．0cm～20．0cm×25．0cm。526个囊肿术前超声均伴后方增强效应,囊腔内均未见异常血流信号。526个囊肿共穿刺655次,i次穿刺成功647次（98．8％）,穿刺失败8次（3次因术中患者体位变动针尖穿出囊腔、5次进针后未抽出囊液）,重新定位后再次穿刺均获成功。509例526个腹盆腔脏器囊肿无水乙醇硬化治疗治愈率达92．4％（486／526）,显效率7．6％（40／526）。结论超声引导穿刺硬化治疗囊肿安全有效,是腹盆腔脏器囊肿治疗首选的方法。     

影像引导经皮穿刺置管灌洗引流在重症急性胰腺炎早期治疗中的应用

目的 探讨影像引导经皮穿刺置管灌洗引流在重症急性胰腺炎（SAP）早期治疗中应用的可行性、临床价值与技术特点.方法 选自我院2008年9月至2010年2月收治的SAP患者56例,随机分为影像引导下经皮穿刺置管灌洗引流治疗组（简称治疗组）（n=27）和常规保守治疗组（简称对照组）（n=29）,检测两组患者治疗前后的实验室指标,对比两组患者治疗后恢复情况及疗效.结果 治疗后两组患者血白细胞计数、血糖、血钙、血、尿淀粉酶等指标出现显著性差异（P＜0.05）,症状体征消失天数、恢复饮食天数、总住院天数等也均有显著性差异（P＜0.01）.治疗组死亡率明显低于对照组（7.4％vs.20.7％,P＜0.05）,有效率则高于对照组（88.9％vs.65.5％,P＜0.05）.结论 影像引导经皮穿刺置管灌洗引流是SAP早期治疗中一种安全可行的方法,其用微创的方法达到开腹手术全面探查、充分灌洗引流治疗SAP的目的,值得临床推广应用.     

中度重症急性胰腺炎早期超声引导下经皮穿刺置管引流术的临床价值

目的 探讨中度重症急性胰腺炎早期超声引导下经皮穿刺置管引流术的临床价值。方法 收集89例中度重症急性胰腺炎患者的临床资料,所有患者在入院后均按照《中国急性胰腺炎诊治指南2013》诊治标准进行规范诊治。根据其是否有在早期行超声引导下经皮穿刺置管引流术分为引流组38例和对照组51例,比较2组住院期间病死率、转重症急性胰腺炎率、转外科手术率、住院时间和并发症（感染、胰腺假性囊肿、腹腔内出血、腹腔间室综合征）发生率等。结果 引流组病死率为5%、转重症急性胰腺炎率为18%、转外科手术率为8%,均低于对照组相应的22%、45%、26%（P均<0.05）。引流组的住院时间短于对照组（P<0.05）。引流组中胰腺假性囊肿和腹腔间室综合征发生率均低于对照组（P均<0.05）。2组患者的感染、腹腔内出血发生率比较差异均无统计学意义（P均>0.05）。结论 早期行超声引导下PCD能有效改善中度重症急性胰腺炎患者预后,缩短其住院时间,减少并发症的发生,且不会增加因穿刺引起的腹腔感染、出血风险。     

Percutaneous paracoccygeal catheter drainage of deep pelvic abscesses using a combination of sonographic and fluoroscopic guidance

Background  The purpose of this study is to demonstrate the feasibility, safety, and success of percutaneous paracoccygeal catheter drainage of deep pelvic abscesses using a combination of sonography and fluoroscopic guidance. Methods  From April 2005 to December 2006, under sonography and fluoroscopic guidance, sixteen patients with deep pelvic abscess underwent percutaneous paracoccygeal drainage. The causes of pelvic abscesses were post-operative complications. The patient was in prone position; the puncture site was first evaluated with sonography. After local anesthesia, a thin needle (22 G) was positioned along the lateral margin of the coccyx to avoid an eventual injury of sciatic nerve or vessels into the deep pelvic abscess under sonography guidance. Small dose of contrast was injected under fluoroscopy to verify the needle. With Seldinger technique catheters were placed for drainage. Catheter drainage was maintained for 9–40 days. Patients underwent clinical follow-up and subsequent imaging as necessary. Results  Neither significant complications nor technical failures were observed. A complete resolution of the abscess was achieved in 14 patients, and significant resolution of abscess was also observed in the other 2 patients. Conclusions  Sonography and fluoroscopic guided percutaneous paracoccygeal drainage is safe, feasible and efficient approach in the treatment of deep pelvic abscess.     

Experiences with CT-guided percutaneous drainage of pyogenic liver abscesses

32 CT-guided percutaneous drainages of bacterial liver abscesses in 25 patients accomplished definitive sanitation in 18 of them (72%). In 7 cases surgical revision was required. Percutaneous drainage of abscesses was able to achieve a temporal improvement in these cases and therefore was an effective pre-surgical measure. There were no complications primarily due to the method itself. The average dwell-time of catheters during drainage of curative percutaneous drainage was 22.5 days. The new therapy concept has proven to be of little discomfort and complications together with high therapeutic effectiveness.