肝脓肿的CT介入诊疗价值  

Interventional Diagnosis and Therapy for Liver Abscess Misdiagnosed as Hepatocellular Carcinoma by CT

作　　者：戚跃勇[1] 邹利光[1] 李妍瑜[1] 谭开彬[1] 王细文[1] 赵晓晏[1] 易习之[1] 

机构地区：[1]第三军医大学附属新桥医院,重庆400037

出　　处：《医学临床研究》2003年第11期825-828,共4页Journal of Clinical Research

摘　　要：目的探讨CT对肝脓肿的介入诊疗价值。方法回顾性分析 18例CT误诊为肝癌的肝脓肿患者的CT及介入诊疗资料。所有患者均行B超或CT引导下经皮穿刺活检 ;7例患者行B超或CT引导下经皮穿刺引流术 ;6例行肝动脉内抗生素灌注治疗。结果18例肝脓肿的CT平扫均为低密度。 14例CT增强扫描中 ,表现为病灶缩小征者 5例 ,一过性强化征 3例 ,蜂窝状强化征 7例 ,延时强化征 5例。 18例肝脓肿患者均通过经皮穿刺活检得以确诊。 7例患者经B超或CT引导下穿刺引流和 6例肝动脉内抗生素灌注治疗后均获痊愈。结论未充分认识肝脓肿的CT强化征象是其CT误诊的主要原因 ,B超或CT引导下经皮穿刺活检与引流术是肝脓肿合理而可靠的诊疗手段 ,肝动脉内抗生素灌注治疗为肝脓肿提供了一种新的简便有效治疗方法。ObjectivesTo evaluate the interventional diagnosis and therapy (IDT) for liver abscess misdiagnosed as hepatocellular carcinoma by computerized tomography (CT).MethodsData of CT and IDT collected from 18 patients with liver abscess misdiagnosed as hepatocellular carcinoma by CT [12 males, 6 females; aged 21～58 yr ; average age, (37±11.5) yr]. were analyzed retrospectively. Ultrasound (US) or CT-guided percutaneous punctures were performed in all cases, US or CT guided percutaneous drainage and infusion of antibiotics through hepatic artery were carried out in 7 cases and 6 cases respectively.ResultsDuring unenhanced CT scanning, the abscesses in 18 cases usually exhibited as hypodense masses; whereas the following signs were noticed in enhanced CT scanning of 14 cases : the mass diminution sign (5 cases), transient hepatic segmental enhancement (3 cases), honeycomb-like enhancement (7 cases) and delayed enhancement sign(5 cases). The diagnoses in 18 cases of liver abscess were confirmed by US or CT guided percutaneous puncture. Seven patients were cured through US or CT guided percutaneous drainage and six patients got recovery through transarterial antibiotic infusion.ConclusionInaccurate recognition of the enhanced CT sign in liver abscess is the main cause of its misdiagnosis. US or CT guided percutaneous puncture and drainage are ideal and reliable measures used to diagnose and treat liver abscess.Infusion of antibiotics through hepatic artery can provide a new therapy with simplicity and efficient effects for treatment of liver abscess.

关 键 词：肝脓肿 介入治疗 CT引导 引流术 经皮穿刺活检 

分 类 号：R657.3[医药卫生—外科学]