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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (15) : 2083 -2086. doi: 10.3877/cma.j.issn.1674-0785.2017.15.005

所属专题: 文献

临床论著

超声引导下经皮穿刺置管引流治疗肝脓肿临床疗效分析
林广荣1, 陈维荣1,(), 徐志杰1, 蔡高阳1, 李彦冲1, 郑培鸿1   
  1. 1. 515041 汕头大学医学院第二附属医院普外科一病区
  • 收稿日期:2017-02-28 出版日期:2017-08-01
  • 通信作者: 陈维荣

Clinical efficacy of ultrasound-guided percutaneous catheter drainage in treatment of liver abscess

Guangrong Lin1, Weirong Chen1,(), Zhijie Xu1, Gaoyang Cai1, Yanchong Li1, Peihong Zheng1   

  1. 1. Department of General Surgery, the Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
  • Received:2017-02-28 Published:2017-08-01
  • Corresponding author: Weirong Chen
  • About author:
    Corresponding Author: Chen Weirong, Email:
引用本文:

林广荣, 陈维荣, 徐志杰, 蔡高阳, 李彦冲, 郑培鸿. 超声引导下经皮穿刺置管引流治疗肝脓肿临床疗效分析[J]. 中华临床医师杂志(电子版), 2017, 11(15): 2083-2086.

Guangrong Lin, Weirong Chen, Zhijie Xu, Gaoyang Cai, Yanchong Li, Peihong Zheng. Clinical efficacy of ultrasound-guided percutaneous catheter drainage in treatment of liver abscess[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(15): 2083-2086.

目的

比较超声引导下经皮穿刺置管引流与手术切开置管引流治疗肝脓肿的临床疗效。

方法

选取2015年6月至2016年6月于汕头大学医学院第二附属医院普外科一病区行超声引导下经皮穿刺置管引流术治疗肝脓肿患者32例,列为超声组;选取2014年1月至2015年1月同院行手术切开置管引流治疗肝脓肿患者32例,列为手术组,回顾性分析2组患者治疗后的治愈率、体温恢复时间、白细胞计数恢复时间、拔管时间、住院总时间、住院总费用以及并发症发生情况并比较各项指标中2组数据之间的差异。

结果

超声组术后治愈率为96.88%,手术组为84.38%,2组间差异无统计学意义(χ2=2.94,P>0.05);超声组体温恢复时间[(3.13±1.04)d]、白细胞计数恢复时间[(4.06±1.32)d]、拔管时间[(10.03±1.18)d]、住院总时间[(14.03±1.15)d],明显较手术组的(7.09±1.42)、(7.28±1.30)、(14.06±1.16)、(18.03±1.21)d短,且2组比较差异具有统计学意义(t=12.197、9.831、13.784、14.091,P<0.05);超声组住院总费用[(8288.81±355.43)元]较手术组总费用[(12 771.98±337.93)元]减少,且2组间差异具有统计学意义(t=51.711,P<0.05);超声组术后切口出血1例,并发症发生率为3.13%,手术组术后切口感染3例,胸腔积液1例,切口出血1例,并发症发生率为15.63%,超声组术后并发症发生率远低于手术组,且2组间差异有统计学意义(χ2=6.56,P<0.05)。

结论

对于肝脓肿治疗,对比手术切开留置引流,超声引导下经皮穿刺留置引流术具有操作精准简单、创伤小、恢复快、并发症发生率低等优点,临床疗效显著。

Objective

To compare the clinical efficacy of ultrasound-guided percutaneous catheter drainage versus incision and drainage in the treatment of liver abscess.

Methods

Thirty-two liver abscess patients who underwent ultrasound-guided percutaneous catheter drainage from June 2015 to June 2016 at our hospital and 32 liver abscess patients who underwent incision and drainage from January 2014 to January 2015 at our hospital were included in this study. The cure rate, time to recovery of body temperature to normal, time to recovery of white blood cell count, time to extubation, hospitalization length, hospitalization cost, and occurrence of complications were compared between the two groups.

Results

The cure rate was significantly higher in the catheter drainage group than in the incision and drainage group (96.88% vs 84.38%, χ2 = 2.94, P>0.05). The time to recovery of body temperature to normal, time to recovery of white blood cell count, time to extubation, and hospitalization length were significantly shorter in the catheter drainage group than in the incision and drainage group [(3.13 ± 1.04) d vs (7.09 ± 1.42) d, (4.06 ± 1.32) d vs (7.28 ± 1.30) d, (10.03 ± 1.18) d vs (14.06 ± 1.16) d, (14.03 ± 1.15) d vs (18.03 ± 1.21) d; t =12.197, 9.831, 13.784, 14.091, P<0.05], respectively. The hospitalization cost was significantly less in the catheter drainage group than in the incision and drainage group [(8288.81 ± 355.43) yuan vs (12 771.98 ± 337.93) yuan, t = 51.711, P<0.05]. The complication rate was significantly lower in the catheter drainage group than in the incision and drainage group (3.13% vs 15.63%, χ2 = 6.56, P<0.05).

Conclusion

Ultrasound-guided percutaneous catheter drainage has the advantages of precise and easy operation, mild trauma, quick recovery, and low complication rate over incision and drainage in the treatment of liver abscess.

表1 2组体温、白细胞计数恢复正常时间、拔管时间、住院时间及住院总费用间的比较(±s
表2 2组患者术后并发症发生率的比较(例)
[1]
Lin YT, Wang FD, Wu PF, et al. Klebsiella pneumoniae, liver abscess in diabetic patients: association of glycemic control with the clinical characteristics [J]. BMC Infec Dis, 2013, 13(1):56.
[2]
Sung CC, Lin CS, Lin SH. Pyogenic liver abscess is associated with increased risk of acute kidney injury: a nationwide population-based cohort study [J]. Medicine(Baltimore), 2016, 95(3):e2489.
[3]
Lardière-Deguelte S, Ragot E, Amroun K, et al. Hepatic abscess: Diagnosis and management [J]. J Visc Surg, 2015, 152(4):231-243.
[4]
Lai SW, Liao KF, Lin CL, et al. Pyogenic liver abscess correlates with increased risk of acute pancreatitis: a population-based cohort study [J]. J Epidemiol, 2015, 25(3):246-253.
[5]
Keller JJ, Kang JH, Sheu JJ, et al. Risk of stroke following diagnosis with pyogenic liver abscess: a nationwide population-based study [J]. Hepatol Int, 2012, 6(4):801-808.
[6]
Huang WK, Lin YC, Chiou MJ, et al. Pyogenic liver abscess as a warning sign for primary liver cancer: a nationwide population-based study [J]. Asian Pac J Cancer Prev, 2013, 14(8):4727-4731.
[7]
杨文雄,康利民,郑永, 等. 细菌性肝脓肿不同治疗方法临床疗效的比较 [J]. 中国医学创新, 2011, 8(12):32-34.
[8]
赵东升. 超声引导经皮穿刺置管引流术与切开置管引流术治疗肝脓肿的疗效比较 [J]. 中国基层医药, 2015, 22(12):1882-1884.
[9]
姚利琴,冯文明,陆文明, 等. 超声引导经皮穿刺置管引流治疗肝脓肿41例临床分析 [J]. 肝胆胰外科杂志, 2011, 23(4):319-320.
[10]
Zerem E, Omerovic S, Kunosic S. Sonographically guided percutaneous treatment of liver abscesses in critically Ⅲ Patients [J]. J Clin Ultrasound, 2014, 9(42):527-533.
[11]
闫楠,高屏,孙健玮. 彩色多普勒超声引导下置管引流治疗细菌性肝脓肿效果分析[J]. 临床与实践, 2016, 14(23):14-15.
[12]
Alkofer B, Dufay C, Parienti JJ, et al. Are pyogenic liver abscesses still a surgical concern?A Western experience [J]. HPB Surg, 2012, 2012:316013.
[13]
Meddings L, Myers RP, Hubbard J, et al. A Population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends [J]. Am J Gastroenterol, 2010, 105(1):117-124.
[14]
Ang TL, Seewald S, Teo EK, et al. EUS-guided drainage of ruptured liver abscess [J]. Endoscopy, 2009, 41(Suppl 2):21-22.
[15]
Alvarez-Uria G, Pakam R, Midde M, et al. Intra-abscess administration of antibiotics through ultrasound-guided percutaneous catheter for the treatment of pyogenic liver abscess [J]. J Clin Diagn Res, 2013, 7(8):1698-1699.
[16]
Chavez-Tapia NC, Hernandez-Calleros J, Tellez-Avila FI, et al. Image-guided Percutaneous procedure plus metronidazole versus metronidazole alone for uncomplicated a-moebic liver abscess [J]. Cochrane Database Syst Rev, 2009, 21(1):48-56.
[17]
蔡翊. B超引导下穿刺置管引流术治疗肝脓肿临床观察 [J]. 中国现代医学杂志, 2013, 23(19):94-96.
[18]
刘玮. 超声引导下经皮穿刺置管引流在肝脓肿治疗中的应用 [J]. 中国当代医药, 2014, 21(30):24-26.
[19]
Ahmed S, Chia CL, Junnarkar SP. Percutaneous drainage for giant pyogenic liver abscessdis it safe and sufficient? [J]. Am J Surg, 2016, 211(1):95-101.
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