超声引导下经皮穿刺引流治疗肝脓肿的效果观察
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摘要
目的从实验室指标及脓肿大小等方面探究肝脓肿治疗中超声引导下经皮穿刺引流术的临床价值。方法选取苏北人民医院消化内科2013年1月-2018年8月行超声引导下经皮穿刺引流治疗肝脓肿的患者79例,排除病例丢失、中途转院或放弃治疗、年龄<18岁、未门诊随访的36例患者,最终入选43例行回顾性研究。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 43例患者均一次性穿刺置管成功,畏寒发热患者36例,31例(86. 1%)患者体温于术后3 d恢复正常,术前术后的WBC、中性粒细胞百分比、AST、ALT及ALP水平比较,差异均有统计学意义(t值分别为6. 668、6. 255、2. 337、3. 001、5. 198,P值均<0. 05);术后脓肿直径(31±28) mm,明显小于术前(74±31) mm,差异有统计学意义(t=18. 517,P <0. 05);平均住院时长为(19. 84±9. 37) d;其中痊愈数为19例,占44. 2%,治疗有效数为24例,占55. 8%。本组43例患者肝脓肿液培养有38例阳性,其中肺炎克雷伯杆菌感染25例,占65. 8%,为最常见病原菌。结论超声引导下经皮穿刺置管引流治疗肝脓肿穿刺成功率高、并发症少、临床疗效可靠,推荐为肝脓肿临床治疗首选。
Objective To investigate the clinical value of ultrasound-guided percutaneous drainage in the treatment of liver abscess from the aspects of laboratory markers and size of abscess. Methods A total of 79 patients with liver abscess who underwent ultrasound-guided percutaneous drainage in Department of Gastroenterology in Northern Jiangsu People's Hospital from January 2013 to August 2018 were enrolled,among whom 36 patients who were lost or transferred,abandoned treatment,had an age pf < 18 years,or were not followed up in the outpatient service were excluded. A total of 43 patients were finally included in the retrospective study. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results All 43 patients achieved a one-time success of puncture and placement of drainage tube. Of all 43 patients,36 had fear of cold and pyrexia,among whom 31(86. 1%) had a normal body temperature on day 3 after surgery,and there were significant changes in leukocyte count,percentage of neutrophils,aspartate aminotransferase,alanine aminotransferase,and alkaline phosphatase after surgery(t = 6. 668,6. 255,2. 337,3. 001,and 5. 198,all P < 0. 05). There was a significant reduction in the diameter of abscess after surgery(74 ± 31 mm vs 31 ±28 mm,t = 18. 517,P < 0. 05). The average length of hospital stay was 19. 84 ± 9. 37 days. Of all 43 patients,19(44. 2%) were cured and 24(55. 8%) had response to treatment. Of all 43 patients,38 had positive results of liver abscess culture,among whom 25(65. 8%)had Klebsiella pneumoniae infection,suggesting that Klebsiella pneumoniae was the most common pathogenic bacteria. Conclusion Ultrasound-guided percutaneous drainage has a high success rate,few complications,and reliable clinical efficacy in the treatment of liver abscess. Therefore,it is recommended as the first choice for the clinical treatment of liver abscess.
Objective To investigate the clinical value of ultrasound-guided percutaneous drainage in the treatment of liver abscess from the aspects of laboratory markers and size of abscess. Methods A total of 79 patients with liver abscess who underwent ultrasound-guided percutaneous drainage in Department of Gastroenterology in Northern Jiangsu People's Hospital from January 2013 to August 2018 were enrolled,among whom 36 patients who were lost or transferred,abandoned treatment,had an age pf < 18 years,or were not followed up in the outpatient service were excluded. A total of 43 patients were finally included in the retrospective study. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results All 43 patients achieved a one-time success of puncture and placement of drainage tube. Of all 43 patients,36 had fear of cold and pyrexia,among whom 31(86. 1%) had a normal body temperature on day 3 after surgery,and there were significant changes in leukocyte count,percentage of neutrophils,aspartate aminotransferase,alanine aminotransferase,and alkaline phosphatase after surgery(t = 6. 668,6. 255,2. 337,3. 001,and 5. 198,all P < 0. 05). There was a significant reduction in the diameter of abscess after surgery(74 ± 31 mm vs 31 ±28 mm,t = 18. 517,P < 0. 05). The average length of hospital stay was 19. 84 ± 9. 37 days. Of all 43 patients,19(44. 2%) were cured and 24(55. 8%) had response to treatment. Of all 43 patients,38 had positive results of liver abscess culture,among whom 25(65. 8%)had Klebsiella pneumoniae infection,suggesting that Klebsiella pneumoniae was the most common pathogenic bacteria. Conclusion Ultrasound-guided percutaneous drainage has a high success rate,few complications,and reliable clinical efficacy in the treatment of liver abscess. Therefore,it is recommended as the first choice for the clinical treatment of liver abscess.
引文
[1]CAO F,LI F,LIU Q,et al.Clinical features of 85 elderly patients with pyogenic liver abscess[J].Pract Geriat,2012,26(2):131.(in Chinese)曹锋,李非,刘强,等.85例老年细菌性肝脓肿的临床特点分析[J].实用老年医学,2012,26(2):131
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[4]JANSEN G,van der HEIJDEN J,OERLEMANS R,et al.Sulfasalazine is a potent inhibitor of the reduced folate carrier:Implications for combination therapies with methotrexate in rheumatoid arthritis[J].Arthritis Rheum,2004,50(7):2130-2139.
[5]BARI S,SHEIKH KA,MALIK AA,et al.Percutaneous aspiration versus open drainage of liver abscess in children[J].Pediatr Surg Int,2007,23(1):69-74.
[6]BI WJ,FAN ZP.Clinical analysis of liver abscesses[J].Chin J Dig,2008,28(2):88-90.(in Chinese)毕文俊,范竹萍.肝脓肿的临床分析[J].中华消化杂志,2008,28(2):88-90.
[7]HU YL,ZHU Y,CHEN LP.Pyogenic liver abscess:Treatment with needle aspiration[J].J Clin Hepatol,2003,19(1):42-43.(in Chinese)胡玉兰,朱瑛,陈丽萍.超声引导经皮针吸治疗肝脓肿[J].临床肝胆病杂志,2003,19(1):42-43.
[8]SUN DS,DIAO XY.An analysis of ultrasound-guided manual puncture and catheter drainage for liver abscess[J].J Imag Res Med Appl,2018,2(15):177-178.(in Chinese)孙东生,刁学耘.超声引导徒手肝脓肿穿刺置管引流术分析[J].影像研究与医学应用,2018,2(15):177-178.
[9]YANG XW,YU XL,CHENG ZG,et al.Application of ultrasound-guided percutaneous catheter drainage in treatment of liver abscess[J].Acad J Chin PLA Med School,2014,35(2):109-111.(in Chinese)杨晓伟,于晓玲,程志刚,等.超声引导下经皮穿刺置管引流在肝脓肿治疗中的应用[J].解放军医学院学报,2014,35(2):109-111.
[10]YAO RQ.Curative effect of ultrasound guided puncture catheter drainage in the treatment of liver abscess[J].Continu Med Edu,2018,32(4):140-141.(in Chinese)姚融情.超声引导下穿刺置管引流治疗肝脓肿的疗效分析[J].继续医学教育,2018,32(4):140-141.
[11]SHI Y,HUANG GM,ZHANG FM,et al.Pyogenic liver abscess:An analysis of 58 cases[J].World Chin J Dig,2012,20(25):2414-2419.(in Chinese)施言,黄光明,张发明,等.细菌性肝脓肿58例[J].世界华人消化杂志,2012,20(25):2414-2419.
[12]CHEN F,ZHANG YT,QIAO HJ,et al.Clinical features of Klebsiella pneumoniae liver abscess[J].J Clin Hepatol,2016,32(4):764-768.(in Chinese)陈帆,张艳亭,乔慧捷,等.肺炎克雷伯菌肝脓肿的临床特征分析[J].临床肝胆病杂志,2016,32(4):764-768.
[13]WU W.Ultrasound-guided percutaneous catheter drainage for the treatment of liver abscess[J].Chin Med Herald,2012,9(7):88-89.(in Chinese)吴为.超声引导经皮穿刺置管引流术治疗肝脓肿[J].中国医药导报,2012,9(7):88-89.
[14]GE JH,WANG B,DING YM.Comparative study of the curative effect of multilocular liver abscess with percutaneous puncture[J].Trauma and Crit Medicine,2018,6(6):360-362.(in Chinese)戈建辉,汪斌,丁佑铭.手术与经皮穿刺治疗多房性肝脓肿临床疗效对照研究[J].创伤与急危重病医学,2018,6(6):360-362.
[15]JIANG X,WU PX,ZHOU FS,et al.Value of ultrasoundguided percutaneous drainage in treatment of large liver abscess[J].Jiangsu Med J,2018,44(1):99-101.(in Chinese)蒋骁,吴鹏西,周锋盛,等.超声引导穿刺引流治疗巨大肝脓肿的应用价值[J].江苏医药,2018,44(1):99-101.
[16]ZHANG SY,CHEN YX.Progress in diagnosis and treatment of pyogenic liver abscess[J].J Clin Hepatol,2018,34(7):1577-1580.(in Chinese)章顺轶,陈岳祥.细菌性肝脓肿诊治进展[J].临床肝胆病杂志,2018,34(7):1577-1580.
[2]TRESKA V,SKALICKY T,LISKA V,et al.Pyogeni-eabseesses of the liver[J].Rozhl Chir,2007,86(6):284-287.
[3]JIN QL,HUANG M,DENG XD,et al.Analysis and management of complications in percutaneous aspirate and catheter drainage treatment for liver abscess[J].Chin J Interv Imaging Ther,2008,5(3):180-182.(in Chinese)金秋龙,黄敏,邓学东,等.超声引导下经皮肝穿刺置管引流治疗肝脓肿并发症分析与防治[J].中国介入影像与治疗学,2008,5(3):180-182.
[4]JANSEN G,van der HEIJDEN J,OERLEMANS R,et al.Sulfasalazine is a potent inhibitor of the reduced folate carrier:Implications for combination therapies with methotrexate in rheumatoid arthritis[J].Arthritis Rheum,2004,50(7):2130-2139.
[5]BARI S,SHEIKH KA,MALIK AA,et al.Percutaneous aspiration versus open drainage of liver abscess in children[J].Pediatr Surg Int,2007,23(1):69-74.
[6]BI WJ,FAN ZP.Clinical analysis of liver abscesses[J].Chin J Dig,2008,28(2):88-90.(in Chinese)毕文俊,范竹萍.肝脓肿的临床分析[J].中华消化杂志,2008,28(2):88-90.
[7]HU YL,ZHU Y,CHEN LP.Pyogenic liver abscess:Treatment with needle aspiration[J].J Clin Hepatol,2003,19(1):42-43.(in Chinese)胡玉兰,朱瑛,陈丽萍.超声引导经皮针吸治疗肝脓肿[J].临床肝胆病杂志,2003,19(1):42-43.
[8]SUN DS,DIAO XY.An analysis of ultrasound-guided manual puncture and catheter drainage for liver abscess[J].J Imag Res Med Appl,2018,2(15):177-178.(in Chinese)孙东生,刁学耘.超声引导徒手肝脓肿穿刺置管引流术分析[J].影像研究与医学应用,2018,2(15):177-178.
[9]YANG XW,YU XL,CHENG ZG,et al.Application of ultrasound-guided percutaneous catheter drainage in treatment of liver abscess[J].Acad J Chin PLA Med School,2014,35(2):109-111.(in Chinese)杨晓伟,于晓玲,程志刚,等.超声引导下经皮穿刺置管引流在肝脓肿治疗中的应用[J].解放军医学院学报,2014,35(2):109-111.
[10]YAO RQ.Curative effect of ultrasound guided puncture catheter drainage in the treatment of liver abscess[J].Continu Med Edu,2018,32(4):140-141.(in Chinese)姚融情.超声引导下穿刺置管引流治疗肝脓肿的疗效分析[J].继续医学教育,2018,32(4):140-141.
[11]SHI Y,HUANG GM,ZHANG FM,et al.Pyogenic liver abscess:An analysis of 58 cases[J].World Chin J Dig,2012,20(25):2414-2419.(in Chinese)施言,黄光明,张发明,等.细菌性肝脓肿58例[J].世界华人消化杂志,2012,20(25):2414-2419.
[12]CHEN F,ZHANG YT,QIAO HJ,et al.Clinical features of Klebsiella pneumoniae liver abscess[J].J Clin Hepatol,2016,32(4):764-768.(in Chinese)陈帆,张艳亭,乔慧捷,等.肺炎克雷伯菌肝脓肿的临床特征分析[J].临床肝胆病杂志,2016,32(4):764-768.
[13]WU W.Ultrasound-guided percutaneous catheter drainage for the treatment of liver abscess[J].Chin Med Herald,2012,9(7):88-89.(in Chinese)吴为.超声引导经皮穿刺置管引流术治疗肝脓肿[J].中国医药导报,2012,9(7):88-89.
[14]GE JH,WANG B,DING YM.Comparative study of the curative effect of multilocular liver abscess with percutaneous puncture[J].Trauma and Crit Medicine,2018,6(6):360-362.(in Chinese)戈建辉,汪斌,丁佑铭.手术与经皮穿刺治疗多房性肝脓肿临床疗效对照研究[J].创伤与急危重病医学,2018,6(6):360-362.
[15]JIANG X,WU PX,ZHOU FS,et al.Value of ultrasoundguided percutaneous drainage in treatment of large liver abscess[J].Jiangsu Med J,2018,44(1):99-101.(in Chinese)蒋骁,吴鹏西,周锋盛,等.超声引导穿刺引流治疗巨大肝脓肿的应用价值[J].江苏医药,2018,44(1):99-101.
[16]ZHANG SY,CHEN YX.Progress in diagnosis and treatment of pyogenic liver abscess[J].J Clin Hepatol,2018,34(7):1577-1580.(in Chinese)章顺轶,陈岳祥.细菌性肝脓肿诊治进展[J].临床肝胆病杂志,2018,34(7):1577-1580.