超声引导经皮肝穿刺置管引流治疗细菌性肝脓肿的临床分析

Clinical analysis of ultrasound-guided percutaneous liver puncture and drainage for bacterial liver abscess

目的探讨超声引导经皮肝穿刺置管引流治疗细菌性肝脓肿的临床疗效与安全性。方法选取62例细菌性肝脓肿患者,采用随机数字表法分为试验组(采用超声引导经皮肝穿刺置管引流治疗,31例)和对照组(采用腹腔镜手术切开引流治疗,31例)。比较两组治疗成功率与临床疗效,基本治疗指标,手术相关并发症发生情况。结果两组均顺利完成治疗,试验组无借助其他方式定位或中转手术者,对照组无中转开腹脓肿切开引流术者,治疗成功率均为100.00%。试验组治愈率70.97%、治疗总有效率100.00%与对照组的77.42%、100.00%比较差异无统计学意义(P>0.05)。试验组置管时间(45.36±6.25)min短于对照组的(91.70±8.92)min,治疗费用(1.43±0.37)万元少于对照组的(2.26±0.54)万元,术后住院时间(18.22±4.75)d长于对照组的(13.36±4.49)d,差异有统计学意义(P<0.05);两组术后拔管时间比较差异无统计学意义(P>0.05)。试验组手术相关并发症发生率16.13%与对照组的6.45%比较差异无统计学意义(P>0.05)。结论以超声引导经皮肝穿刺置管引流治疗细菌性肝脓肿的临床疗效和安全性与腹腔镜手术切开引流基本相当,不过前者在置管操作时间与治疗费用方面更具优势,临床可根据患者实际情况优先考虑使用,但依旧无法完全代替手术治疗。

Objective To explore the clinical efficacy and security of ultrasound-guided percutaneous liver puncture and drainage for bacterial liver abscess.Methods A total of 62 patients with bacterial liver abscess were selected and divided into an experimental group(treated with ultrasound-guided percutaneous liver puncture and drainage,31 cases)and a control group(treated with laparoscopic incision and drainage,31 cases)by random number table method.The success rate of treatment,clinical efficacy,basic therapeutic indicators and the incidence of surgery-related complications were compared between the two groups.Results Both groups successfully completed treatment.The experimental group did not use other methods to locate or convert to surgery,while the control group did not convert to open abdominal abscess incision and drainage surgery.The success rate of treatment was 100.00%for both groups.The cure rate of the experimental group was 70.97%and the total effective rate of treatment was 100.00%,which had no statistical significance compared with 77.42%and 100.00%of the control group(P>0.05).The experimental group had shorter catheterization time of(45.36±6.25)min than(91.70±8.92)min in the control group,less treatment cost of(1.43±0.37)ten thousand yuan than(2.26±0.54)ten thousand yuan in the control group,and longer postoperative hospitalization time of(18.22±4.75)d than(13.36±4.49)d in the control group.The difference was statistically significant(P<0.05).There was no significant difference in postoperative extubation time between the two groups(P>0.05).The incidence of surgery-related complications in the experimental group was 16.13%,and difference was not statistically significant compared with 6.45%in the control group(P>0.05).Conclusion The clinical efficacy and safety of ultrasound-guided percutaneous liver puncture and drainage in the treatment of bacterial liver abscess is basically the same as that of laparoscopic surgical incision and drainage,but the former has more advantages in the operation time and treatment cost of catheterization,which can be prioritized according to the actual situation of the patients in the clinic,but it still cannot completely replace surgical treatment.