经皮经肝穿刺引流序贯经皮肾镜治疗难治性肝脓肿的初步探讨

段昌虎; 刘晓晨; 丁建龙; 段建峰; 赵喜荣; 杨帆; 吴林; 赵李飞; 邰升

doi:10.3969/j.issn.1001-5256.2021.11.026

经皮经肝穿刺引流序贯经皮肾镜治疗难治性肝脓肿的初步探讨

DOI: 10.3969/j.issn.1001-5256.2021.11.026

1.
西安交通大学医学院附属汉中三二〇一医院肝胆外科，陕西汉中 723000
2.
哈尔滨医科大学附属第二医院肝胆外科，哈尔滨 150001

基金项目:

黑龙江省自然科学基金 (H2018025)

详细信息

通信作者:
刘晓晨，liuxiaochen@126.com

中图分类号: R575
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出版历程
- 收稿日期: 2021-03-17
- 录用日期: 2021-03-30
- 出版日期: 2021-11-20

A preliminary study on percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy in treatment of refractory liver abscess

1.
Department of Hepatobiliary Surgery, The Affiliated 3201 Hospital of Xi'an Jiaotong University School of Medicine, Hanzhong, Shaanxi 723000, China
2.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China

Research funding:

Natural Science Foundation of Heilongjiang (H2018025)

摘要

摘要: 目的探讨肝动脉介入栓塞术后形成的复杂性肝脓肿行经皮经肝穿刺引流序贯经皮肾镜坏死组织清除引流治疗的效果。方法回顾性分析2018年1月—2020年12月西安交通大学医学院附属汉中三二〇一医院肝胆胰脾外科收治的3例肝动脉介入栓塞术后形成难治性肝脓肿患者(胰十二指肠切除术后肝转移瘤行介入形成肝脓肿1例、巨块型肝癌反复行介入治疗后肝脓肿1例、外伤性肝破裂行肝动脉介入栓塞术后继发肝脓肿1例)，3例患者均采用经皮经肝穿刺引流序贯经皮肾镜治疗难治性肝脓肿，对其具体治疗过程进行总结。结果 3例患者均经CT检查、血常规、降钙素原、血培养及临床表现诊断为难治性肝脓肿，采用常规超声或CT引导下经皮经肝穿刺置管、敏感抗生素治疗疗效欠佳，后序贯经皮肾镜行肝脓肿坏死组织清除引流后肝脓肿均治愈，预后良好。结论针对介入术后形成的难治性肝脓肿，常规穿刺治疗效果欠佳，且无法或患者难以耐受外科手术时，采用经皮经肝穿刺引流序贯经皮肾镜治疗复杂性肝脓肿是安全、有效的。
- 肝脓肿 /
- 引流术 /
- 内窥镜检查, 消化系统
Abstract: Objective To investigate the clinical effect of percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy for necrosectomy and drainage in the treatment of refractory liver abscess after transcatheter arterial embolization (TACE). Methods A retrospective analysis was performed for three patients with refractory liver abscess after TACE in The Affiliated 3201 Hospital of Xi'an Jiaotong University School of Medicine from January 2018 to December 2020, and among the three patients, one had the formation of liver abscess after TACE for hepatic metastases after pancreaticoduodenectomy, one had liver abscess after repeated TACE for massive hepatocellular carcinoma, and one had secondary liver abscess after TACE for traumatic hepatic rupture. All three patients received percutaneous transhepatic drainage and sequential percutaneous nephroscopy for the treatment of refractory liver abscess, and their specific treatment process was summarized. Results All three patients were diagnosed with refractory liver abscess based on CT, routine blood test, procalcitonin, blood culture, and clinical manifestation. Percutaneous transhepatic catheterization under the guidance of conventional ultrasonography or CT and effective antibiotics had an unsatisfactory therapeutic effect, and after sequential percutaneous nephroscopy was performed for necrosectomy and drainage, liver abscess was cured and the patients had good prognosis. Conclusion For refractory liver abscess after TACE, when routine puncture treatment has an unsatisfactory therapeutic effect or a patient cannot tolerate surgical operation, percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy is safe and effective in the treatment of refractory liver abscess.
- Liver Abscess /
- Drainage /
- Endoscopy, Digestive System

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图 1 患者A治疗前后肝脓肿变化情况

注：a，肝转移瘤介入术后肝脓肿；b，超声引导置管引流术后脓腔增大；c，更换CT置管引流脓腔进行性增大；d，经皮肾镜清理脓腔内脓性絮状物；e，肾镜清理1周后脓腔明显变小；f，肾镜清理2次后脓腔基本消失。

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图 2 患者B治疗前后肝脓肿变化情况

注：a，肝癌介入术后肝脓肿；b，经皮肾镜清理后脓腔基本消失。

下载: 全尺寸图片幻灯片

图 3 患者C介入术后形成的巨大肝脓肿

注: a, 外伤性肝破裂; b, 肝动脉介入栓塞术后巨大肝脓肿。

下载: 全尺寸图片幻灯片

表 1 3例难治性肝脓肿患者一般资料

患者	年龄(岁)	性别	原发疾病	基础疾病	手术史	肝脓肿大小	WBC(×10⁹/L)	高热时间	Child-Pugh分级
A	57	男	胰腺癌伴肝转移瘤	原发性高血压	Whipple术后、TACE	14 cm×9 cm×12 cm	28.5	介入后4 d	A级
B	65	男	巨块型肝癌	2型糖尿病	TACE(3次)	8 cm×6 cm×6 cm	26.8	介入后6 d	B级
C	23	女	重度复合、肝破裂	创伤性湿肺	TACE	12 cm×10 cm×8 cm	32.6	介入后2 d	A级

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参考文献(12)

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