细菌性肝脓肿经皮穿刺置管引流与细针抽吸疗效比较

Percutaneous Catheter Drainage Versus Needle Aspiration in Management of Bacterial Liver Abscess

目的比较B超引导下经皮穿刺置管引流(percutaneous catheter drainage,PCD)与经皮细针抽吸(percutaneous needle aspiration,PNA)治疗细菌性肝脓肿患者的临床疗效。方法回顾我科1989年1月至2009年12月期间收治的206例细菌性肝脓肿的临床资料,其中经皮穿刺治疗(包括PCD与PNA)96例,分别为PCD组(n=56)和PNA组(n=40),比较2组间治疗成功率、并发症率、死亡率及住院时间。结果 2组患者间性别、年龄、有无糖尿病、白蛋白水平及脓肿的部位、个数、大小、来源等差异均无统计学意义(P>0.05)。PCD组与PNA组并发症率、死亡率及住院时间差异均无统计学意义〔1.79%比2.50%,P=1.000;1.79%比2.50%,P=1.000;(19.2±13.1)d比(20.2±12.9)d,P=0.887〕,但PCD组治疗成功率明显高于PNA组(96.43%比75.00%,P=0.002)。对于直径小于5 cm的单发肝脓肿,PNA组与PCD组治疗成功率相当(13/13比16/17,P=1.000)。结论 PCD治疗细菌性肝脓肿较PNA更加有效,对于直径小于5 cm的单发肝脓肿,PNA是可选的替代措施。

Objective To determine the effectiveness of percutaneous catheter drainage（PCD） and to compare PCD with percutaneous needle aspiration（PNA） in the management of bacterial liver abscess.Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively.The outcomes of 96 patients receiving percutaneous treatment including PCD（PCD group,n=56） and PNA（PNA group,n=40） were compared,including the length of hospital stay,rates of procedure-related complications,treatment success,and death.Results There was no statistical difference in patients＇ demographics or abscess characteristics between two groups（P0.05）.The morbidity,mortality,and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%,1.79% vs 2.50%,and（19.2±13.1） d vs（20.2±12.9） d,respectively,and the P values were 1.000,1.000,and 0.887,respectively.There was statistically significant difference in successful rate between two groups（96.43% vs 75.00%,P=0.002）,but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group（13/13 vs 16/17,P=1.000）.Conclusions PCD is more effective than PNA in the management of bacterial liver abscess.PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.