ct引导下经皮穿刺引流治疗深部腹腔脓肿44例体会.docVIP

精品论文 参考文献 CT引导下经皮穿刺引流治疗深部腹腔脓肿44例体会 1.江苏省射阳县人民医院CT室 224300；2.南京医科大学第一附属医院放射科 210029 【摘 要】目的：探讨CT引导下经皮穿刺引流治疗深部腹腔脓肿的临床应用价值。方法：随访并回顾分析44例接受猪尾巴导管植入引流治疗的深部腹腔脓肿病例。结果：44例腹腔脓肿均获成功穿刺。共引流脓腔52个，其中采用细针穿刺经导丝引入猪尾巴导管法（seldinger法）11个；采用猪尾巴套管直接穿刺法41例。2例因其他原因死亡，2例多房脓肿引流后外科手术治疗，其余40例治愈，治愈率达90.91%。并发症5例，发生率11.36%，其中出血1例，术后疼痛2例，导管滑脱2例。结论：CT引导下经皮穿刺治疗深部腹腔脓肿，是值得推广的介入微创技术。 【关键词】：深部腹腔脓肿；经皮穿刺脓肿引流；CT导向引流 [Abstract]Objective：To investigate the clinical value of the CT-guided percutaneous drainage（PAD）to treat the deep intra-abdominal abscess.Methods：44 patients with deep abdominal abscesses were followed up who had underwent PAD treatment between January 2014 and June 2014，and retrospective analysis the effectiveness and safety of PAD.Results：All procedures were performed successfully under local anesthesia and CT guidance.Pigtail drainage catheters were placed in 52 abscess cavities of 44 cases using the direct puncture method or Seldinger technique.Success was defined as complete resolution of the intra-abdominal abscess in 40 cases.2 patients died because of other complications，2 patients with multilocular abscess received open surgical drainage after PAD.The success rate of PAD was 90.91%（n=44）.PAD-related complications were seen in 5 patients（11.36%），with bleeding in 1 case，postoperative pain in 2 cases，catheter slippage in 2 cases.Conclusion：CT guided PAD to treat the deep abdominal abscess is encouraged as an effective，safe and minimally invasive interventional radiological technique. [Keywords]：Deep intra-abdominal abscess，Percutaneous abscess drainage，CT-guided drainage 腹腔脓肿是腹腔间隙细菌感染后，局部组织坏死液化形成的脓腔。随着介入技术的发展，CT引导下经皮穿刺引流已越来越多地用于临床，使许多腹腔脓肿患者，通过微创的介入手术，加上有效的抗炎、支持治疗获得痊愈，避免了一些不必要的开腹引流，减轻了患者的痛苦。但深部腹腔脓肿穿刺易损伤肠管、血管、胆管等，导致严重并发症，仍是穿刺治疗的难点。本文回顾2014年1月-2014年6月期间，在南京医科大学附属第一医院经CT引导下经皮抽吸及置管引流的44例腹腔深部脓肿病例，旨在总结临床经验，探讨穿刺技巧，减少手术并发症，提高其临床应用价值。 1．资料与方法 1.1 一般资料 44位患者中，男21例，女23例，年龄17岁~82岁，平均年龄52岁。44例腹腔脓肿，其中继发于胃及贲门手术6例，肝胆手术及脾切除8例（2例合并胆瘘），胰十二指肠手术6例，急性胰腺炎6例，妇科及产科手术7例，结肠癌术后1 例，小肠克罗恩1例，兰