Rajak C L, Gupta S, Jain S, Chawla Y, Gulati M, Suri S
Department of Radio-Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
AJR Am J Roentgenol. 1998 Apr;170(4):1035-9. doi: 10.2214/ajr.170.4.9530055.
This study was designed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses.
In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or catheter drainage (n = 25) along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given catheter drainage (however, these patients were not included in the catheter drainage group). For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. In patients with multiple abscesses (seven in aspiration group and five in catheter group), all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved.
Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations, catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the abscess cavity was significantly (p < .05) greater in the aspiration group than in the catheter group (11 days versus 5 days), the average time taken for total resolution of abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks.
Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.
本研究旨在确定并比较超声引导下经皮穿刺针吸术和经皮导管引流术治疗肝脓肿的疗效。
在一项随机研究中，50例肝脓肿患者（男38例，女12例；年龄范围2 - 72岁，平均年龄35岁）（阿米巴性肝脓肿20例，化脓性肝脓肿11例，病因不明的肝脓肿19例）接受了经皮穿刺针吸术（n = 25）或导管引流术（n = 25），并同时接受了适当的抗菌治疗。在分配到针吸组的患者中，使用18号针抽吸脓肿腔。对首次抽吸无反应的患者，每位仅尝试重复抽吸一次；对第二次抽吸无反应则视为治疗失败，这些患者接受导管引流（然而，这些患者不包括在导管引流组中）。对于导管引流，采用Seldinger技术将8 - 12法式导管置入脓肿腔。对于多发性肝脓肿患者（针吸组7例，导管组5例），除小于3 cm的脓肿外，所有脓肿均接受经皮治疗。对患者进行随访，以评估经皮治疗的结果、住院时间以及任何并发症的发生情况。住院期间每三天进行一次超声检查。患者出院后，定期进行临床和超声检查，直至脓肿完全消退。
尽管在25例患者中，经皮穿刺针吸术在一次（n = 11）或两次（n = 4）抽吸后仅15例（60%）成功，但导管引流术在所有25例患者中均治愈（100%）（p < 0.05）。在成功治疗的患者中，两个治疗组的临床改善平均时间和平均住院时间相似。尽管脓肿腔大小缩小50%所需的平均时间在针吸组显著（p < 0.05）长于导管组（11天对5天），但两组脓肿完全消退所需的平均时间相同（15周）。未出现重大并发症。在随访期间（8至37周），临床和超声检查均未记录到复发情况。
我们的结果表明，经皮导管引流术在治疗肝脓肿方面比针吸术更有效。针吸术若限于两次尝试，失败率较高。
