CT引导下穿刺闭合式引流术颈深部脓肿的治疗效果分析

CT-guided puncture closed drainage for deep neck abscesses

目的 探讨CT引导下穿刺闭合式引流术颈深部脓肿的有效性和安全性.方法 选取2005年1月至2016年6月扬州大学附属医院耳鼻咽喉-头颈外科收治的25例单侧颈深部脓肿患者.所有患者均经抗感染治疗失败,并采取CT引导下经皮穿刺置管引流术治疗.采用套管穿刺法进行置管,经穿刺置管引流术治疗失败后立即行手术切开引流.结果 25例患者中,5例患者的脓液中无细菌生长,20例患者的脓液中有细菌生长,阳性率为80％.所有患者均一次性穿刺成功.2例患者因并发同侧多个间隙感染及1例患者穿刺后第2天出现广泛的组织内积气而需清创引流.1例患者拔管出院后死亡.对24例患者随访3个月,均无复发.结论 CT引导下经皮穿刺置管引流术是一种安全、高效、低成本的治疗方法,可以考虑作为替代开放性手术切开引流治疗对药物治疗无效的颈深部单房脓肿.此方法易被高龄患者及伴有全身性疾病的患者耐受,住院时间短,同时可减少并发症的发生.

Objective To investigate the validity and safety of CT-guided puncture closed drainage in the treatment of unilocular deep neck abscesses. Methods A retrospective study was performed on 25 cases of patients with unilateral deep neck abscesses who were admitted from January 2005 to June 2016. All patients failed in the anti-infective therapy,and they would receive the CT-guided puncture closed drain-age. Catheter placement was carried out using Trocar technique in all cases. Open surgical drainage was per-formed when percutaneous catheter drainage procedures failed. Results A total of 25 cases of patients were enrolled,including 5 cases had no bacteria in the pus,20 cases had bacteria growth in the pus,and the posi-tive rate was 80%. All patients had puncture success in one time. Two patients complicated with multiple interstitial infection,one patients complicated with tissue gas,who needed irrigation and debridement. One patient died after hospital discharge. Followed up 24 patients for three months,no patient recurred. Conclu-sion CT-guided puncture closed drainage is a safe,efficient,low-cost treatment,which can be considered as an alternative to open surgery incision drainage treatment of unilocular deep neck abscesses when drug treatment is invalid. This technique is easy to be tolerated by elderly patients and patients with systemic dis-eases. The length of stay is short and complications can be reduced.