猪尾巴导管经CT定位穿刺引流在肝胆胰疾病中的应用

目的评价CT定位引导下猪尾巴导管穿刺引流治疗肝胆胰外科疾病的临床有效性及安全性。方法回顾分析52例接受CT引导下猪尾巴导管穿刺引流治疗的肝胆胰疾病患者的临床资料，其中肝脓肿19例，急性梗阻性胆囊炎15例，胰周及腹膜后积液18例。分析治疗结果及穿刺相关问题。结果52例患者均顺利置管引流，穿刺引流后患者体温及血白细胞计数均较术前明显下降。3例引流后效果不佳行急诊外科手术，49例引流成功患者避免了手术或急诊手术治疗，成功率94．2％（49／52）。其中2例因引流管堵塞而更换引流管重新置管，1例引流45天后出现腹壁肌肉间隙脓肿，1例胆囊穿刺后出现胆汁性腹膜炎；其余48例患者均未出现穿刺引流相关并发症。结论CT引导下猪尾巴导管穿刺引流治疗肝脓肿、急性梗阻性胆囊炎、胰周及腹膜后局限性积液、积脓，操作安全、有效，并发症发生率低，可单独应用在一定范围内替代外科引流或作为手术前的准备。

CT- guided percutaneous pigtail catheter drainage for treatment of hepatopancreatobiliary diseases

Objective To evaluate the clinical effectiveness and safety of CT - guided percutaneous pigtail catheter drainage in the management of hepatopancreatobiliary diseases. Methods The clinical data of 52 patients underwent CT -guided percutaneous pigtail catheter drainage for the management of varies of liver diseases, including liver abscess （19 cases）, acute obstructive cholecystitis （15 cases）, peripancreatic and retroperitoneal fluid collections （18 cases）, were analyzed retrospectively. The clinical outcomes and complications were recorded and analyzed. Results The pigtail catheter was smoothly placed in all 52 patients, and all the patients showed clinical improvement with abatement of fever and decrease of white blood cell count compared with prepuncture. 3 cases refered to surgery debridement lately for the ineffectiveness after drainage. 49 cases succeeded in avoiding the surgery or emergency surgical treatment （success rate： 94.2% , 49/52）. Catheters＇side holes were blocked in 2 cases and the catheters were replaced to make good drainage. 1 case had abdominal muscle layer abscess after drainage for 45 days and another case suffered from peritonitis after drain- age. All the other 48 patients did not have complications associated with puncture and drainage. Conclusion The proce- dure of CT - guided pereutaneous pigtail drainage is a safe and effective treatment option which can be used alone as an alternative to surgery, or as an adjunct to operation in the management of liver abscess, acute obstructive cholecystitis, peripancreatic and retroperitoneal fluid collections.