经皮穿刺引流治疗肝脓肿12年临床经验  

Percutaneous catheter drainage for liver abscess:twelve years' clinical experience

作　　者：廖伟[1] 畅智慧[1] 刘兆玉[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,沈阳110004

出　　处：《介入放射学杂志》2013年第10期843-847,共5页Journal of Interventional Radiology

摘　　要：目的总结分析细菌性肝脓肿的临床及CT特征,评价经皮穿刺引流术的疗效。方法回顾性分析近12年来住院治疗的肝脓肿患者的临床资料及CT特征。分析的CT特征包括:病灶数量、是否多房、囊实性、腔内是否含气等。分析影响疗效的因素,并探讨影响住院时间及引流时间的因素。采用统计学方法包括单样本T检验、卡方检验和Fisher精确切验。统计学软件采用SPSS16.0。结果计有578例患者纳入本研究。主要临床症状为发热,和右上腹疼痛。52例(9.0%)患者存在感染性休克,80例(13.8%)患者并发血流感染。实验室检查异常主要为白细胞及中性粒细胞百分比升高,白蛋白降低,肝酶升高,总胆红素升高,C反应蛋白(CRP)升高。416例(71.9%)血细菌培养或脓汁细菌培养阳性。致病菌占首位的为肺炎克雷伯菌(69.7%)。经皮穿刺引流术治疗肝脓肿的技术成功率99.7%,临床成功率97.4%,病死率0.9%。并发症5例(0.9%),平均住院时间(13.1±7.4)d。平均带管引流时间(29.2±9.3)d。住院时间的影响因素为:脓肿含气、合并感染性休克、合并其他部位感染、合并肝胆胰恶性肿瘤;带管引流时间的影响因素为:脓肿多房、实性,合并肝胆胰恶性肿瘤。合并肝胆胰恶性肿瘤是影响治疗成功率的唯一因素。结论对于化脓性肝脓肿,只要不合并肝胆胰恶性肿瘤,经皮穿刺引流都应该成为治疗的首选。脓肿多房、实性、含气、合并感染甚至感染性休克等因素没有影响介入治疗的临床成功率,只是延长了住院时间或带管引流时间。Objective To summarize the clinical and CT features of liver abscess, and to evaluate the clinical effect of percutaneous catheter drainage in treating liver abscess. Methods A total of 578 patients with liver abscess, who were admitted to authors＇ hospital during the period from Jan. 2000 to May 2012, were enrolled in this study. The clinical data and the CT findings were retrospectively analyzed. CT features used for analysis included the number of lesion, unilocular or multiloeular appearance, cystic or solid in nature, gas in cavity, etc. The factors which might influence the therapeutic effect were analyzed. And the factors influencing the hospitalization days and drainage time were also explored. The results were statistically analyzed by using independent-sample t-test, X2 test and Fisher＇s exact test with the software of SPSS version 16.0. Results The main clinical symptoms were fever and pain in the right upper quadrant of abdomen. Infective shock was seen in 52 cases （9.0o/0） and hematogenous infection was complicated in 80 cases （13.8%）. Laboratory studies showed that the main abnormalities included increase of white blood cell and neutrophil percentage, decrease of albumin level, elevated liver enzymes, increased total bilirubin, increase of C- reaction protein, etc. Positive bacteria culture of blood or pus was found in 416 patients （71.9%）, and the main pathogen was Klebsiella pneumoniae （69.7%）. Technical success rate of percutaneous catheter drainage for liver abscess was 99.7%, while the clinical success rate was 97.4% with a mortality rate of 0.9%. Complications occurred in 5 patients （0.9%）. The mean hospitalization day was （ 13.1 ± 7.4） days, and the average drainage time was （29.2 ± 9.3） days. The factors that influenced the hospitalization day were abscess containing gas, complications such as infective shock, infection at other sites, concomitant hepatobiliary and pancreatic malignant tumor, etc. The factors that influenced the drainage time included multil

关 键 词：化脓性肝脓肿 经皮穿刺引流术 体层摄影术  X线计算机 

分 类 号：R575.4[医药卫生—消化系统]