X-perCT及超声引导穿刺引流个体化治疗方案在肾脓肿患者中的应用

The application of X-perCT and ultrasound-guided puncture in the individualized treatment of renal abscess

目的 分析X-perCT及超声引导下经皮肾镜穿刺引流术在治疗肾脓肿中的临床价值.方法 回顾性分析2012年5月至2020年6月在本院收治的47例肾脓肿患者的临床资料.将患者随机分为X-perCT穿刺组(25例)和BK超声穿刺组(22例),观察各组的穿刺和引流效果,并对脓液进行细菌培养分析.结果 BK超声穿刺组有15例一次性穿刺成功,7例因脓肿多房、脓肿腔壁较厚先行B超穿刺失败,再次经X-perCT定位穿刺成功.X-perCT穿刺组均成功在X-perCT定位下穿刺成功.所有患者均未发生穿刺并发症.将所有患者抽吸的脓液进行细菌培养,42例细菌培养成功,其中金葡球菌27例,大肠杆菌12例,克雷伯菌3例,5例培养未见明显细菌.X-perCT穿刺组的穿刺成功率、穿刺费用、患者满意度均高于BK超声穿刺组,而引流时间、重新置管率低于BK超声穿刺组,差异均有统计学意义(均P<0.05).结论 X-perCT及超声引导下经皮肾镜穿刺引流都简便安全,术后恢复快,并发症少.X-perCT引导更精准,重新置管率更低,患者满意度更高,值得推广应用.

Objective To compare and analysis the clinical value of X-perCT and ultrasoundguided percutaneous renal puncture and drainage in the treatment of renal abscess.Methods Clinical datas of 47 patients who suffered from renal abscess were collected from May 2012 to June 2020 were retrospectively analyzed.The patients were randomly divided into X-perCT puncture group(25 cases)and BK ultrasound puncture group(22 cases).The puncture and drainage effects of each group were observed,and the bacterial culture of the pus was analyzed.Results In the BK ultrasonic puncture group,there were 15 cases of one-time successful puncture and 7 cases of B-ultrasound puncture.Bultrasound puncture failed due to multiple abscess and thick abscess cavity wall,but the puncture was successful again through X-perCT location.In all the X-perCT puncture groups,the puncture was successful under the X-perCT positioning.No puncture complications occurred in all patients.Bacterial culture was carried out on the pus pumped from all patients.The bacterial culture was successful in 42 cases,including 27 cases of Staphylococcus aureus,12 cases of Escherichia coli,3 cases of Klebsiella,and 5 cases of no obvious bacteria.The success rate,puncture cost and patient satisfaction of XperCT puncture group were higher than those of BK ultrasound puncture group,while the drainage time and recatheter rate were lower than those of BK ultrasound puncture group,the differences were stat istically significant(all P<0.05).Conclusions Percutaneous renal puncture drainage guided by XpercCT and ultrasound is feasible,the operation is simple and safe,fast postoperative recovery,fewer complications,The X-perCT guide is more accurate and the rate of re-catheterization is lower,patient satisfaction is high,especially for patients with multilocular renal abscess,but the cost is slightly higher.The two puncture methods,individualized in clinical application,complement each other,and they were worth popularizing and applying.