肝脓肿的介入处理

目的：探讨肝脓肿经皮穿刺介入引流的临床应用及术后拔管的时间窗。方法：回顾分析1999年11月．2007年11月62例肝脓肿住院患者，按照治疗方法不同分为介入治疗组（介入组，32例）和外科治疗组（外科组，30例）介入组在DSA引导下行肝脓肿穿刺引流，抽吸脓液、冲洗脓腔，并留置肝外引流管作持续冲洗及引流；外科组采用外科手术切开引流并留置引流管。结果：介入组的平均住院时间（11．29±1．64）d、留管时间（8．08±1．29）d、并发症0例，与外科组比较，两组差异有统计学意义（P〈0．05），而平均退热时间及有效率方面两组差异无统计学意义（P〉0．05）。结论：肝脓肿的介入治疗对肝组织的损伤较小，并发症少，操作简单，术后拔除外引流管的时间窗以选择在无发热后3d为宜。

Interventional Management of Hepatic Abscess

Objective： To explore the clinical use of percutaneous drainage in hepatic abscess and the best time to remove the drainage tube. Methods： Sixty-two patients with hepatic abscess were studied retrospectively. These patients comprised an intervention group （n=32） and a surgery group （n=30）. The intervention arm received DSA-guided liver puncture, which involved suction and rinsing of the abscess and placement of a extrahepatic catheter for sustained irrigation and drainage, while the surgery arm received open drainage followed by indwelling of the drainage tube. Results： The intervention group showed statistical differences as compared with the surgery group in mean hospital stay （11.29±1.64） days, mean time on drainage （8.08± 1.29） days and complication rate （0%） （P〈0.05）, but not in mean time to resolution of fever and in treatment efficacy （P〉0.05）. Conclusion： Interventional management of hepatic abscess appears to be associated with less invasiveness, less morbidity and simpler procedure. Removal of the drainage tube may be considered at 3 days after resolution of fever.