超声引导下经皮肝穿刺抽脓法和置管引流法治疗艾滋病并发肝脓肿患者临床效果分析  

Clinical application of ultrasound-guided percutaneous aspiration and percutaneous catheter drainage for treatment of liver abscess patients with or without AIDS

作　　者：王雪梅 张瑶[1] 杨学平[1] 王玥[1] 张记[1] Wang Xuemei;Zhang Yao;Yang Xueping(Department of Ultrasound,Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院超声科,北京市100015

出　　处：《实用肝脏病杂志》2021年第4期573-576,共4页Journal of Practical Hepatology

摘　　要：目的分析艾滋病(AIDS)并发肝脓肿患者临床特点并观察在超声引导下介入治疗的效果。方法2013年6月~2019年12月我院诊治的74例肝脓肿患者,其中39例有AIDS基础病,均在内科治疗的基础上采用超声引导下经皮肝穿刺抽脓法(PA)和置管引流法(PCD)治疗。结果两组患者主要临床表现为发热,AIDS患者出现腹痛或腹部不适症状者占56.4%,显著高于非AIDS组的31.4%(P<0.05);AIDS组和非AIDS组白细胞(WBC)计数分别为7.2×10^(9)/L和10.6×10^(9)/L,中性粒细胞百分比分别为73.7%和78.8%(P<0.05);血清C反应蛋白(CRP)分别为62.8 mg/L和120.9 mg/L(P<0.05),降钙素原(PCT)分别为0.3 ng/ml和0.4 ng/ml(P>0.05);AIDS组合并肝外感染者占71.8%,显著高于非AIDS组的48.6%(P<0.05);AIDS组脓液培养病原菌难度大,种类多,而非AIDS组则以肺炎克雷伯菌为主;AIDS组和非AIDS组脓肿大小分别为9.4±3.6 cm和9.0±3.1 cm(P>0.05);AIDS组和非AIDS组治愈率分别为87.2%和94.3%(P>0.05),两组之间无显著性差异。结论AIDS并发肝脓肿患者有其特殊的临床特点,采用超声引导下介入治疗安全、可靠、疗效显著。Objective The aim of this study was to analyze the clinical application of ultrasound-guided percutaneous aspiration(PA)and percutaneous catheter drainage(PCD)for treatment of liver abscess patients with or without acquired immune deficiency syndrome(AIDS).Methods The clinical data of 74 patients(with underlying AIDS in 39)with liver abscess were admitted to our hospital between June 2013 and December 2019,and all patients underwent PA or/and PCD for treatment at base of supporting management.Results The main clinical manifestations in the two groups were fever,and the incidence of abdominal pain or abdominal discomfort in AIDS group was 56.4%,significantly higher than that in non-AIDS group(31.4%,P<0.05);in AIDS group and non-AIDS group,the white blood cell count was 7.2×10^(9)/L and 10.6×10^(9)/L,and the percentage of neutrophil was 73.7%to 78.8%(P<0.05);serum C-reactive protein(CRP)levels were 62.8 mg/L and 120.9 mg/L(P<0.05),while serum procalcitonin levels were 0.3 g/L and 0.4 g/L(P﹥0.05);the incidence of extrahepatic infection in AIDS group was 71.8%,significantly higher than 48.6%in non-AIDS group(P<0.05);it was difficult to culture out pathogens from pus from AIDS patients,and the pathogens varied,while the lebsiella pneumoniae was the main pathogen in patients without AIDS;in AIDS group and non-AIDS groups,the size of abscess were 9.4±3.6 cm and 9.0±3.1 cm(P>0.05),the postoperative complications were 17.9%and 8.6%,and the cure rate was 87.2%and 94.3%(P>0.05).Conclusion The patients with AIDS and liver abscess have their unique clinical features,and the interventional therapy under ultrasound guidance is safe,reliable and efficacy.

关 键 词：肝脓肿 艾滋病 超声引导 经皮肝穿刺抽脓法 置管引流法 治疗 

分 类 号：R575.4[医药卫生—消化系统] R512.91[医药卫生—内科学]