超声引导经皮穿刺抽吸置管治疗肝脓肿

目的 评价超声引导下穿刺抽吸，置管引流治疗肝脓肿的疗效。方法 对26例肝脓肿患者共26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 22例患者行穿刺抽脓冲洗注药1-3次，4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，26例患者脓肿完全吸收，全部痊愈。结论 超声引导下经皮穿刺抽吸，置管引流术是一种疗效显著，安全，微创的治疗方法，具有重要的临床应用价值。     

超声引导在腹部脓肿穿刺中的应用价值

目的探讨超声引导下穿刺在腹部脓肿诊断治疗中的临床应用价值。方法28例腹部脓肿经专用穿刺探头引导,经皮穿刺抽吸脓液,以甲硝唑反复冲洗后注入抗生素,必要时置管引流。结果28例腹部脓肿一次性穿刺成功率达91.4%,2例脓肿置管引流成功率100%,穿刺治疗后脓腔完全消失23例,治疗效果显著。结论超声引导下腹部脓肿穿刺及置管引流,不仅能有效地治疗腹部脓肿,而且对于明确诊断腹部脓肿具有一定的价值。     

超声引导下穿刺抽吸治疗哺乳期乳腺脓肿的临床效果

目的：观察超声引导下穿刺抽吸治疗哺乳期乳房脓肿的临床效果。方法：哺乳期乳房脓肿患者186例,分为超声引导穿刺组93例和脓肿切开置管引流组93例,比较两组治疗效果。结果：两组患者脓肿均治愈,随访1～4周未见复发。超声引导穿刺组疼痛评分2.21±0.31分低于脓肿切开置管引流组的4.34±0.64分,满意度评分92.32±5.32分高于脓肿切开置管引流组的71.36±7.53分,复哺乳率96.77%高于脓肿切开置管引流组的73.12%,差异均有统计学意义（P<0.05）。结论：超声引导下乳房脓肿穿刺抽脓创伤小、效果好、对乳腺结构和形态影响小,患者满意度评分及复哺乳率高,可以作为乳房脓肿治疗的首选方法。     

B超导向下脓肿抽吸,冲洗,置药及置管引流治疗肝脓肿

本文报告95例肝脓肿在使用抗菌素的同时,采用超声引导下抽吸脓腔、冲洗、置药及置管引流进行治疗。其中细菌性肝脓肿90例,单发79例、多发11例,阿米巴肝脓肿5例。经穿刺、抽吸、冲洗、置药治疗者92例,另3例抽吸、冲洗、置药并置管引流治疗,疗效迅速,治愈率达100％,本组无并发症出现。作者认为超声引导下脓腔抽吸、冲洗、置药及置管引流术,病人痛苦少,疗效高,安全可靠,是治疗肝脓肿的首选方法。     

超声引导下穿刺治疗小儿阑尾炎术后腹腔脓肿

目的 探讨超声引导下抽吸或置管引流治疗小儿阑尾炎术后腹腔脓肿的价值.方法 对35例小儿阑尾炎术后腹腔脓肿患儿行经超声引导下穿刺抽脓或置管引流.治疗后行超声随访.结果 35例患儿共进行41次抽吸和2次置管引流,在超声引导下均一次穿刺成功抽脓,6例1周后进行第2次穿刺抽脓,均无严重并发症.35例患儿中31例均于抽吸引流后48 h内症状缓解;4例穿刺抽脓后无明显改善,其中2例行置管引流后病情好转,2例中转开腹.结论 超声引导下穿刺抽吸或置管引流治疗小儿阑尾炎术后腹腔脓肿是一种安全有效的治疗方法.     

B超引导下穿刺置管引流治疗肝脓肿42例临床护理

目的:探讨在B超引导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿的临床护理。方法:对肝脓肿患者42例51个病灶行B超引导下经皮穿刺,脓腔直径<5cm行穿刺抽吸治疗,直径≥5cm抽吸置管引流治疗,并做好术前、术中、术后护理,加强营养与护理,达到治疗目的,预防并发症。结果:42例肝脓肿治愈率为100%(51/51),未发生并发症。结论:B超介导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿切实可行,具有微创、安全简便、经济的优点。     

阴道超声引导穿刺治疗盆腔脓肿的价值

目的探讨超声引导下经阴道抽吸或置管引流治疗盆腔脓肿的价值。方法对临床保守治疗无效的31例盆腔脓肿女性患者行经阴道超声引导下穿刺抽脓或置管引流,治疗后行超声随访。结果 31例患者共进行38次抽吸和2次置管引流,在阴道超声引导下均一次穿刺成功抽脓,6例1周后进行第2次穿刺抽脓,1例行第3次穿刺,均未发生严重并发症。31例患者中26例于抽吸引流后48 h内症状缓解,2例穿刺抽脓后症状无明显改善而行置管引流,后病情好转。本组治愈率为93.5%。结论超声引导下经阴道抽吸或置管引流盆腔脓肿是一种安全有效的治疗方法。     

CT引导下经皮肝穿刺治疗细菌性肝脓肿患者的护理

目的:探讨在CT引导下经皮肝穿刺治疗细菌性肝脓肿患者的临床护理。方法:对肝脓肿患者23例行CT引导下经皮穿刺,脓腔直径<5cm行穿刺抽吸治疗,直径≥5cm行抽吸置管引流治疗,并做好术前、术中、术后护理,加强营养,预防并发症。结果:23例肝脓肿治愈率为100%。结论:CT引导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿切实可行,具有创伤小、恢复快、疗效好、费用低的特点,加强临床护理是其疗效的重要保障。     

B超引导下介入治疗细菌性肝脓肿93例效果分析

目的 探讨B超引导下介入治疗在细菌性肝脓肿治疗中的临床应用价值。方法 对接诊的93例细菌性肝脓肿忠者实施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可作为临床治疗细菌性肝脓肿的首选方法。     

超声引导下穿刺抽脓并腔内注射甲硝唑治疗肝脓肿

目的 总结26例超声引导下经皮肝穿抽脓并腔内注射甲硝唑溶液治疗肝脓肿情况，探讨其疗效。方法 对26例患者分别行1－3次超声引导下不置管穿刺治疗，与同期20例外科手术切开置管引流治疗肝脓肿进行疗效对比。结果 非手术肝脓肿患者脓腔在15天至45天愈合，平均为21天。与外科手术比较疗效无明显差异。结论 超声引导下穿刺治疗肝脓肿是一种简单可行、疗效确切的治疗方法。     

细菌性肝脓肿及膈下脓肿的超声引导穿刺治疗

对49例细菌性肝脓肿及膈下脓肿患者在超声直视引导下行穿刺抽脓；对脓液黏稠正有坏死组织块、抽脓不彻底的患者置管引流，每日冲洗。有48．98％(24／49)的患者行1次抽脓治疗，24、49％(12／49)行2次，8．16％(4／49)行3次，4．08％(2／49)行4次穿刺抽脓；另14．29％(7／49)行置管引流。所有患者均治愈出院，治疗后1、3、6个月随访肝内无脓腔。这表明细菌性肝脓肿及膈下脓肿的超声引导穿刺抽脓、置管引流是一种有效、可靠的治疗方法。     

Successful antimicrobial therapy of hepatic, intra-abdominal and intrapelvic abscesses.

Antimicrobial therapy without surgical drainage or therapeutic aspiration was effective in the management of four patients with deep abscesses ranging in diameter from 1.3 to 10.0 cm. Two of the patients had multiple hepatic abscesses, one had hepatic, intra-abdominal and intrapelvic abscesses, and one had an intrapelvic abscess alone. Anaerobic bacteria were isolated from the blood or abscesses in all four patients, and an aerobic-anaerobic infection was present in one patient. The patients were treated with metronidazole, alone or in combination with other antibiotics, for 3 to 6 weeks. Therefore, in selected patients with deep abscesses, a therapeutic trial of antimicrobial agents instead of surgery may be justified.     

10例脑脓肿的诊断及治疗

目的:总结10例脑脓肿的临床诊断及相关治疗方法与疗效。方法:10例脑脓肿中,2例行CT增强检查,8例行MRI增强扫描,1例应用罗氏芬联合甲硝唑治疗6周。4例行脓肿及包膜切除术,5例经CT定位或B超引导下行脓肿穿刺引流术,术后常规应用抗生素4周。结果:1例复发,8例治愈,1例死亡。结论:脑脓肿早期发现,采用适当方法,疗效较好。     

超声引导下肝脓肿经皮穿刺针单纯抽吸与置管引流疗效比较

目的 对比超声引导下肝脓肿经皮穿刺针(PTC)抽吸与超声引导下置管引流的疗效。 方法 2014年1月—2015年12月选取在湖州市中心医院超声科就诊的40例细菌性肝脓肿患者,采用随机数字表将40例细菌性肝脓肿患者分为2组,其中A组患者(20例)在超声引导下用PTC针行单纯抽吸术,B组患者(20例)在超声引导下行置管引流术。观察2组一次性治愈率、体温恢复正常时间、疼痛减弱时间、脓肿腔消失时间及住院治疗时间,随访有无复发及并发症发生情况等。 结果 B组20例患者治愈,有效率为100%;A组13例患者一次穿刺治愈,有效率为65%,4例2～5 d后行第2次穿刺后治愈,其余3例在2次穿刺后仍有较大脓腔,行置管引流术后治愈。2组患者的有效率比较差异有统计学意义(P＜0.05)。A组体温恢复正常时间、疼痛减弱时间、脓肿消失时间及住院时间分别为(3.0±0.6) d、(2.5±0.6) d、(12.5±3.5) d、(15.6±4.0) d,均长于B组的(2.0±0.5) d、(1.2±0.5) d、(7.2±2.0) d、(10.3±3.0) d,差异有统计学意义(P＜0.05)。A组并发症发生率为40.0%(8/20),B组并发症发生率为5.0%(1/20),2组并发症比较差异有统计学意义(χ2=5.161,P＜0.05)。 结论 细菌性肝脓肿经超声引导下置管引流管治疗,能有效提高患者治疗效果,减轻患者疼痛感,缩短患者治疗时间,效果显著,值得推广。      

小儿急性咽后脓肿的诊断与治疗

目的总结小儿急性咽后脓肿的诊治体会。方法回顾性分析8例小儿急性咽后脓肿患者的临床表现及治疗经过。结果5例首诊儿科并延误诊断。5例进行了颈部影像学检查，诊断准确率为100％。8例中6例经口内脓肿切开引流治愈；2例脓肿突然破裂，1例抢救后治愈，1例因全身感染中毒症状重而死亡。结论小儿急性咽后脓肿易被误诊，影像学检查有助提高诊断准确率，脓肿切开引流是最直接有效的治疗手段，倒提患儿是脓肿突然破裂时实用有效的急救措施。对于全身感染中毒症状较重的患儿，应及早行对症治疗。     

Ultrasound-guided needle aspiration of amoebic liver abscess.

This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications.     

小切口置管负压引流治疗乳腺脓肿的疗效分析

目的探讨小切口置管负压引流方法在乳腺脓肿中的治疗效果。方法回顾性分析40例乳腺脓肿患者,其中15例行小切口置管负压引流治疗,25例行常规手术切开引流治疗,比较两者在住院时间、愈合时间、术后并发症、瘢痕大小、继续哺乳等方面的差异。结果置管组的平均住院时间为（7.9±1.7）d,治愈时间为（12．3±2.5）d,瘢痕长度为（0.5±0.1）cm,手术切开组的平均住院时间为（11.9±3.6）d,治愈时间为（228±35）d,瘢痕长度为（2.9±0.8）cm,置管组在住院时间、愈合时间、瘢痕大小等方面明显优于手术切开组,两者比较差异有统计学意义（P〈0.01）。术后手术切开组并发2例乳瘘,术后均停止继续哺乳;置管组未发生1例乳瘘,术后有8例患者继续哺乳。结论小切口置管负压引流方法在治疗乳腺脓肿中具有微创、简便、害今疗赫明确并发症少等特点．     

Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review

Background

A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008–2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia.

Methods

Forty-two patients (29 males and 13 females; aged between 28–93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised.

Results

Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups.

Conclusion

The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.     

经皮穿刺置管引流或抽吸治愈胆漏的临床应用

目的:评价采用经皮穿刺置管引流或多次抽吸的方法治疗胆漏。方法:对各种原因发生的胆漏36例,在超声引导下经皮穿刺,置入引流管或多次抽吸治疗胆漏。结果:36例均在3d～8d治愈,平均约5.4d,无1例并发症。36例中21例行置管引流方法,15例行多次抽吸方法。结论:经皮穿刺置管引流或多次抽吸治疗胆漏的方法安全可靠,缩短了治愈时间,免除了再次手术的创伤,且方法简单易行。     

Postoperative subphrenic abscess following gastrectomy for gastric cancer

From 1985 to 1989, a total of 598 gastric cancer patients underwent gastrectomies in the First Department of Surgery at Kurume University School of Medicine. Of these, 24 patients (4.0%) incurred a subphrenic abscess, postoperatively. Subphrenic abscesses occurred most frequently after total gastrectomies at a rate of 17 of 197 (8.8%) cases. Leaking gastrointestinal anastomoses were responsible for 12 of the 17 (70.5%) abscesses. In 384 cases of distal gastrectomy, only 6 (1.6%) cases with a subphrenic abscess occurred, and only 3 were due to anastomotic leakage. Among the total of 24 cases with subphrenic abscesses, 16 (67%) were related to an anastomotic leakage including a pancreatic fistula, while the other 8 (33%) showed no leakage by contrast roentgenography. When chest roentgenography shows a pleural effusion and an elevation of the diaphragm, then a subphrenic abscess must be suspected. The majority of patients were treated by replacing the intraabdominal drainage catheter inserted during the gastrectomy with a larger catheter. The overall operative mortality rate was 4.1% due to a death in only one (MOF) patient.