CT引导下经皮肝脓肿穿刺置管引流术的应用

目的观察CT引导下经皮肝脓肿穿刺置管引流治疗肝脓肿的疗效和临床应用价值。方法对临床诊断明确并经实验室及影像学检查证实的36例患者在CT引导下经皮肝脓肿穿刺引流,术中置管,术后定时冲洗并积极进行有效的抗生素治疗。结果 36例肝脓肿患者经皮穿刺置管引流术治疗后,临床症状消失,无并发症发生,经B型超声或CT复查脓肿消失,全部治愈出院。结论 CT引导下经皮肝脓肿穿刺置管引流术具有操作简便、手术创伤小、住院费用低、疗效肯定等优点,是临床治疗肝脓肿的有效方法之一。     

肝动脉化疗栓塞后肝脓肿形成的原因及治疗

目的 探讨肝动脉化疗栓塞（HACE）后正常肝实质并发脓肿的原因及治疗。方法 6例肝癌患者经HACE术后,正常肝实质内形成脓肿。明确诊断后,在B超引导下行经皮穿刺脓肿引流和对脓腔进行抗菌素灌洗。结果 4例患者脓肿愈合,2例患者脓腔明显缩小。结论 分析肝内脓肿形成的主要原因为：（1）胆道损伤;（2）门静脉内癌栓形成;（3）胆囊动脉及胆道周围动脉丛的栓塞。在B超引导下经皮穿刺脓肿引流及选用敏感抗菌素每天对脓腔进行灌洗是治疗HACE术后并发肝脓肿的有效手段。     

CT引导下肝脓肿穿刺置管引流术的探讨

目的 探讨CT引导下肝脓肿穿刺引流术的方法和疗效.方法 本组20例肝脓肿患者,均经临床、生化和影像学(CT)检查确诊为肝脓肿,行CT引导下定位穿刺抽吸并置管引流.脓肿位于肝左叶6例,肝右叶9例,肝2叶5例.结果 14例为单个脓肿,6例为多发脓肿,单个脓肿经1次抽吸后脓肿完全消失9例,1例经2次抽吸基本消失,多发或多房脓肿穿刺先抽较大脓肿,后抽较小脓肿,或分次抽吸,20例均放置引流管并冲洗,平均引流置管时间为19.2 d,所有患者至随访截止日未见复发.结论 CT引导下穿刺抽吸引流足治疗肝脓肿的非常有效的方法.     

经皮肝穿刺置管引流治疗肝脓肿5例

目的：了解经皮肝穿刺置管引流治疗肝脓肿的临床观察。方法：5例在影像引导下经皮肝穿刺置管引流治疗,本组5例,男3例,女2例;年龄46~68岁。均进行CT及临床确诊。结果：成功为5例患者在影像引导下经皮肝穿刺置管引流治疗肝脓肿,总有效率100%。结论：经皮肝穿刺置管引流治疗肝脓肿方法直接、安全、简便、有效,是目前治疗肝脓肿最有发展前景、值得推广的好方法。     

CT定位穿刺置管引流治疗细菌性肝脓肿的临床价值

目的 评价CT定位穿刺置管引流治疗肝脓肿的疗效.方法 回顾性分析经临床随访确诊的27例肝脓肿患者,所有患者均在发病1周内行CT定位下穿刺置管,对肝脓肿行持续引流及抗生素冲洗,随访观察分析治疗效果.结果 27例肝脓肿患者经过置管引流冲洗后,1月内症状消失,治愈率达100％,疗效满意.结论 CT定位下穿刺置管引流治疗肝脓肿创伤小、疗效确切,有较高的临床价值,值得推广.     

CalliSpheres载药微球治疗原发性肝癌并发肝脓肿4例分析

【摘要】 目的 探讨CalliSpheres载药微球治疗原发性肝癌并发肝脓肿的原因及治疗效果。方法回顾性分析4例原发性肝癌患者采用CalliSpheres载药微球行肝动脉化疗栓塞术（DEB-TACE）后并发肝脓肿的临床资料，分析肝脓肿发生的原因，总结治疗方案及预后。结果 4例患者均在彩超引导下行经皮肝穿刺脓腔引流术，脓液行细菌培养及药敏试验，脓液分别培养出表皮葡萄球菌、产气荚膜梭菌、脆弱拟杆菌、普通变形杆菌，经抗菌药物及引流治疗后临床症状均缓解，脓腔吸收2例，明显缩小2例。3例患者随访6～12个月存活，1例患者于引流术后3个月因脑梗死死亡。结论 CalliSpheres DEB-TACE治疗原发性肝癌可并发肝脓肿且原因较多，采用经皮穿刺脓肿引流可取得较好的治疗效果。     

超声引导经皮肝穿刺引流术治疗细菌性肝脓肿

 目的 评价超声引导经皮肝穿刺引流术在细菌性肝脓肿治疗中的临床应用价值.方法 对35例超声引导下经皮肝穿刺引流(穿刺组)和同期36例手术切开引流(手术组)治疗细菌性肝脓肿的疗效进行对照分析.结果 穿刺组治愈率(97.1 %)与手术组治愈率(94.4%)差异无统计学意义(P＞0.05),而穿刺组在住院天数、术后血象恢复正常时间、术后体温恢复正常时间、脓腔消失时间、治疗费用方面明显优于手术组(P＜0.01),术后并发症在穿刺组明显少于手术组(P＜0.05). 结论与传统手术切开引流术相比,经皮肝穿刺引流术具有安全、微创、简便、康复快和经济等优点,可以作为细菌性肝脓肿首选治疗方法.     

超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径>3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。     

超声介入治疗细菌性肝脓肿的两种方法疗效比较

 目的 对比研究超声引导下经皮肝穿刺细针抽吸术与置管引流术治疗细菌性肝脓肿的疗效。方法 细菌性肝脓肿98例,其中直径≥5 cm 46例,直径＜5 cm 52例。对以上两种大小的脓肿,分别采取超声引导下经皮肝穿刺细针抽吸术和置管引流术两种方法治疗,比较两种方法治疗后脓肿消失时间、患者住院时间、血象、体温恢复正常时间等。结果 直径≥5 cm肝脓肿,置管引流术组在住院天数、脓腔消失时间等方面优于细针抽吸术组（P＜0.05）,在术后血象、体温恢复正常时间方面两种方法无统计学差异（P>0.05）。直径＜5 cm肝脓肿,两种方法在住院天数、脓腔消失时间、术后血象、体温恢复正常时间方面无统计学差异（P>0.05）。结论 对于直径≥5 cm、直径＜5 cm的细菌性肝脓肿,应分别首选超声引导下经皮肝穿刺置管引流术、细针抽吸术。     

CT引导置管联合胆道镜治疗胰周脓肿13例

目的探讨CT引导经皮穿刺置管引流联合胆道镜病灶清除在治疗重症胰腺炎合并胰周脓肿的方法和疗效。方法 13例重症胰腺炎合并胰周脓肿患者,在超声引导失败或引流疗效不佳时,在CT定位引导下行病灶穿刺置管引流,引流1周待假性窦道形成后,经窦道用胆道镜多次清除脓腔内坏死组织。结果 13例患者置管引流均成功,每例患者行胆道镜脓腔清理2~7次,其中8例治愈,5例假性囊肿形成。无一例发生手术并发症。结论 CT引导置管引流联合胆道镜脓腔清理是急性重症胰腺炎合并胰周脓肿的微创治疗方法之一,其创伤小,疗效佳,不易受胸腔内和胃肠道气体干扰,并发症少,对提高重症胰腺炎的疗效有重要价值。     

超声引导穿刺置管引流治疗肝脓肿的临床应用及护理

目的:探讨了超声引导经皮穿刺置管引流冲洗与直接冲洗治疗肝脓肿的临床应用价值及护理。方法:对52例肝脓肿患者,63个病灶行超声引导经皮穿刺,小于5cm的脓肿直接穿刺抽吸治疗,大于5cm的肝脓肿置管引流。同时做好术前准备,全身支持营养,心理护理。临床应用效果良好。结果:52例患者的63个病灶完全治愈,穿刺术后24小时无不良反应,4周治愈率达到78%,8周治愈率达到83%,6个月治愈率达到100%,无护理并发症。结论:超声引导经皮穿刺置管引流抽吸冲洗治疗肝脓肿,方法简单,安全有效,创伤小,可取代外科手术治疗肝脓肿。细致周到的护理是治疗成功的重要保证。     

71例恶性梗阻性黄疸介入治疗的围手术期护理

目的 总结71例恶性梗阻性黄疸患者经皮穿刺胆道引流的围手术期护理经验.方法 认真细致地做好术前准备,重视心理护理,加强营养支持,保证患者的体质能耐受手术.术后严密监测生命体征,观察黄疸消退情况.保持引流管通畅,做好穿刺局部及引流管的护理.结果 71例恶性梗阻性黄疸患者术前准备充分,术后护理得当,黄疸消退明显,胆道梗阻解...     

MEBO纱条脓腔引流治疗乳房脓肿的疗效观察

目的 观察湿润烧伤膏(MEBO)纱条引流治疗乳房脓肿的临床效果.方法 32例乳房脓肿患者行脓肿切开术后,用MEBO纱条填塞脓腔引流治疗.结果 30例(93.75%)患者经3次～5次MEBO纱条换药治疗后创口愈合,无1例有乳瘘形成.结论 MEBO纱条脓腔引流治疗乳房脓肿效果显著.     

Computerized tomography-guided drainage of postoperative abdominal fluid collections]

INTRODUCTION: We report our personal technique and the results of CT-guided percutaneous drainage of postoperative abdominal fluid collections. MATERIAL AND METHODS: January 1990 to March 1998, eighty-three patients were treated for postoperative abdominal fluid collections. Forty-eight patients had undergone bowel resection, 11 laparoscopic cholecystectomy, 3 cholecystectomy, 5 splenectomy, 3 cephalopancreasectomy, 6 hepaticojejunal anastomosis, 4 hepatic resection, 2 laparocele, 1 hysterectomy. The complications had developed few days to about one year postoperatively. The suspicion of abdominal fluid collection was supported by clinical and laboratory findings. All patients were submitted to a preliminary CT scan to locate the fluid collection, assess its morphology and relationships with surrounding structures, and plan the safest access route. After local anesthesia, a trial fine needle (Chiba 20-22 G) aspiration was performed and then the draining tube was inserted into the collection under CT guidance; the tube caliber depended on the fluid amount and viscosity. After drainage, the tube was removed if CT showed complete resolution of the fluid collection; otherwise it was left in place for subsequent washing of the cavity. Based on clinical, laboratory and CT findings, another CT-guided percutaneous drainage was judged necessary in 30 patients, 2-9 days after the first one. Drainage was considered successful when sepsis resolved and no further percutaneous/surgical drainages were needed. RESULTS: CT-guided percutaneous drainage was successful in 61 of 83 patients (73.5%); the fluid collection resolved after one drainage in 26/61 patients, in 2-9 days in 18/61, and after a second CT-guided drainage in 17/61. Drainage was not resolutive in 22 of 83 patients, because major postoperative complications required laparotomic surgery; these complications were fistulas (anastomotic in 12 cases; pancreatic in 5 and biliary in 3) and segmentary bowel necrosis in 2 cases. Intracavitary bleeding as a catheter-related complication occurred only in one patient with an anterior abdominal wall abscess. CONCLUSIONS: CT-guided percutaneous drainage offers many advantages over surgery: it is less invasive, can be repeated and requires no anesthesia; there are no surgery-related risks and lower morbidity and mortality rates. Moreover, subsequent hospitalization is shorter and costs are consequently reduced. We conclude that CT-guided percutaneous drainage is the method of choice in the treatment of postoperative abdominal fluid collections.     

CT导引下胰腺穿刺活检的护理体会

目的探讨护理干预在CT导引下胰腺穿刺活检中的应用价值。方法对21例实施CT导引下胰腺穿刺活检的病例分别在术前、术中、术后给予护理干预,积极配合整个穿刺过程。结果本组所有患者均积极配合穿刺,顺利完成穿刺,一次穿刺成功率为100%,术后未见明显并发症。结论护理干预是保证患者配合穿刺,缩短穿刺时间,避免和减少术后并发症上不可或缺少。     

Percutaneous CT-guided drainage of splenic abscess

OBJECTIVE: The objective of our study was to determine the current role of percutaneous CT-guided drainage as an alternative to surgical treatment of splenic abscesses. CONCLUSION: Splenic abscess is an uncommon entity that can be treated percutaneously. CT-guided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen.     

A new interventional technique for percutaneous treatment of drainage-resistant liver abscess

The objective of this case report is to describe a device that can be used as a minimally invasive alternative for the treatment of drainage-resistant liver abscess. The device uses pulse lavage to fragment and evacuate the semi-solid contents of a liver abscess. The treatment of liver abscesses consists of percutaneous drainage, antibiotics and treatment of the underlying cause. This approach can be ineffective if the contents of the abscess cavity are not liquid, and in those cases open surgery is often needed. Here, we describe for the first time a new minimally invasive technique for treating persistent liver abscesses. A patient developed a liver abscess after a hepatico-jejunostomy performed as a palliative treatment for an unresectable pancreatic head carcinoma. Simple drainage by a percutaneously placed pig-tail catheter was insufficient because of inadequate removal of the contents of the abscess cavity. After dilatation of the drain tract the persistent semi-solid necrotic contents were fragmented by a pulsed lavage device, after which the abscess healed uneventfully. The application of pulsed lavage for debridement of drainage-resistant liver abscesses proved to be an effective and minimally invasive alternative to open surgery.The mainstays of the treatment of liver abscesses are drainage and antibiotics. Drainage can be performed by ultrasound- or CT-guided percutaneous drain placement or by surgical techniques using laparoscopy or laparotomy. The most appropriate method of drainage is controversial and varies from open surgery to repeated percutaneous punctures. Surgical drainage had a higher success rate and a shorter hospital stay than percutaneous drainage in a retrospective study of 80 patients with large pyogenic liver abscesses [1]. By contrast, a randomised trial revealed that drainage by repeated puncture was equally as effective as percutaneous drainage in which an indwelling catheter was left behind [2]. For most patients with liver abscesses, percutaneous drainage is an effective treatment.In patients with highly viscid, sticky pus or infected necrotic tissue, it is much more difficult to clean the abscess cavity because of occlusion of the relatively narrow percutaneous drain and inability to remove the semi-solid contents. In these cases, surgery is performed to create a large opening and adequate drainage of the contents of the abscess cavity. Even partial liver resection has been advocated for the treatment of drainage-resistant liver abscesses [3].Here, we describe a new technique that has the potential to treat a non-resolving liver abscess efficiently after simple percutaneous drainage. The technique uses pulsed lavage, which is able to fragment and evacuate non-liquefied debris in a liver abscess using a percutaneous approach.     

分析肝脓肿介入治疗住院时间的影响因素

目的分析肝脓肿行经皮穿刺置管引流术的影响因素。 方法选择DSA引导下经皮肝穿刺置管引流并采用不同冲洗液冲洗脓腔治疗肝脓肿116例,进行资料分析,患者平均（59.98±16.73）岁,其中男性76例,女性40例。既往有糖尿病49例,无糖尿病67例;脓肿单发者48例,多发者68例;住院期间有并发症者104例,无并发症的12例。对穿刺液经行细菌培养,大肠杆菌阳性者20例,肺炎克雷白杆菌52例,其他致病菌8例,培养阴性36例。按冲洗液不同分为两组：A组,置管后先使用甲硝唑注射液冲洗,细菌培养及药敏结果明确后改用含敏感抗生素液体冲洗脓腔,共68例;B组,置管后全程使用甲硝唑冲洗,共48例。 结果116例肝脓肿患者治疗有效率100%。统计分析结果显示性别、有无并发症对住院时间影响的差异无统计学意义;年龄与住院时间无相关关系;糖尿病、脓肿数目及不同冲洗方法对住院时间的影响差异有统计学意义。 结论DSA引导下经皮肝穿刺置管引流冲洗治疗肝脓肿疗效确切,糖尿病是影响住院时间的重要因素;多发肝脓肿的住院时间较单发的明显延长;采用敏感抗生素溶液冲洗肝脓肿效果更显著。