Department of Radiodiagnosis, RPGMC, Kangra, HP, India.
J Ultrasound. 2020 Dec;23(4):553-562. doi: 10.1007/s40477-020-00440-3. Epub 2020 Mar 27.
To evaluate and compare the efficacy of intermittent needle aspiration and continuous catheter drainage in ultrasound-guided management of liver abscesses.
This was a prospective, randomised study conducted on 100 patients (88 males and 12 females; age range 22-74 years) with liver abscess(es) and having abscess size more than 5 cm, divided into two groups: Percutaneous needle aspiration (PNA) (n = 50) and percutaneous catheter drainage (PCD) (n = 50). Criteria of exclusion were: rupture of abscess before intervention; prior intervention; uncorrectable coagulopathy; concomitant biliary tract malignancy. In the PNA group, pus was aspirated by an 18-gauge needle using freehand technique and the number of aspirations was limited to two. Failure of abscess size to decline below 50% of the original diameter or of clinical improvement after second aspiration was considered as failure of aspiration. In the PCD group, drainage was done by 12-French catheters using Seldinger technique. Drainage was considered as failure if abscess cavity did not resolve and laparotomy was needed to evacuate the pus cavity.
The success rate in the PNA group was 88% and 92% in the PCD group; however, this difference was statistically not significant, suggesting that both are equally efficacious. The total duration of hospital stay (mean 6.8 days [PNA] vs 10.5 days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9 days [PNA] vs 10.2 days [PCD]; p value:0.026) were significantly less in the PNA group. One major complication was seen in our study: peritonitis due to peri-catheter leak in PCD group.
Both procedures are equally efficacious in the management of liver abscesses; however in view of less duration of hospital stay, patient safety and comfort, procedure simplicity, and the reduced cost, needle aspiration should be used as the first-line procedure in the treatment of liver abscess (even in abscesses more than 5 cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.
评估和比较超声引导下经皮间断性针吸与连续导管引流治疗肝脓肿的疗效。
这是一项前瞻性、随机研究，纳入 100 例（88 例男性，12 例女性；年龄 22-74 岁）肝脓肿患者（脓肿直径＞5cm），将其分为两组：经皮针吸（PNA）组（n=50）和经皮导管引流（PCD）组（n=50）。排除标准：介入前脓肿破裂；既往有介入史；不可纠正的凝血障碍；合并胆道恶性肿瘤。在 PNA 组中，使用徒手技术用 18 号针抽吸脓液，抽吸次数限制为 2 次。如果脓肿直径下降未超过原始直径的 50%或第二次抽吸后临床改善不明显，则认为抽吸失败。在 PCD 组中，使用 Seldinger 技术插入 12-French 导管引流。如果脓肿腔未完全清除且需要剖腹手术清除脓腔，则认为引流失败。
PNA 组的成功率为 88%，PCD 组为 92%；然而，差异无统计学意义，表明两种方法同样有效。PNA 组的总住院时间（平均 6.8 天[PNA] vs 10.5 天[PCD]；p 值：0.011）和干预与出院之间的平均时间（5.9 天[PNA] vs 10.2 天[PCD]；p 值：0.026）明显短于 PCD 组。我们的研究中观察到 1 例主要并发症：PCD 组因导管周围漏导致腹膜炎。
两种方法治疗肝脓肿的疗效相当；然而，鉴于住院时间更短、患者安全性和舒适度更高、操作更简单以及成本更低，在治疗肝脓肿（即使脓肿直径＞5cm）时，应将针吸作为一线治疗方法。对于对第二次抽吸无反应的病例，应保留导管引流。
