超声引导下经皮穿刺置管硬化肾囊肿的临床应用

目的 观察在超声引导下经皮穿刺置管引流、囊液引流后注射无水酒精硬化单纯性肾囊肿(囊肿长径均＞100 mm)的效果和安全性.方法 从2012年3月至2013年4月对21例较大肾囊肿患者在超声引导下经皮穿刺置入猪尾巴管并接引流袋,囊液引流干净后注射无水酒精治疗,观察术后对囊肿的治疗情况.结果 21例肾囊肿患者在超声引导下经皮穿刺置管硬化肾囊肿的治疗中获得成功,术后随访3～ 12个月,治愈率达95％,有效率达100％.结论超声引导下经皮穿刺置管硬化较大肾囊肿疗效明显,比以往单纯用穿刺针抽液及硬化治疗疗效显著.     

超声引导下置管联合聚桂醇追加泡沫硬化治疗非寄生虫性肝囊肿的临床研究

目的:评价经超声引导下穿刺置管联合聚桂醇追加泡沫硬化治疗非寄生虫性肝囊肿的临床疗效及不良反应。方法:回顾分析我院于2016年1月-2019年5月收治的82例非寄生虫性肝囊肿患者(囊肿直径>5.0cm),观察组41例,对照组41例,观察组行置管联合聚桂醇追加泡沫硬化治疗,对照组行置管联合无水乙醇硬化治疗,分别于治疗后1、3、6月进行随访,观察两组患者的临床疗效及不良反应。结果:观察组的治愈率92.7%,对照组的治愈率75.6%,两组比较差异有统计学意义(P<0.05)。对照组的不良反应率51.2%,观察组的不良反应率7%,两组比较差异有统计学意义(P<0.01)。结论:超声引导下置管联合聚桂醇泡沫追加硬化治疗明显优于单纯穿刺无水乙醇硬化治疗,且安全性及有效性高,值得临床进一步推广。     

超声引导下置管引流术治疗盆腔恶性肿瘤术后淋巴囊肿的临床应用价值

目的探讨超声引导下经腹置管引流术治疗盆腔恶性肿瘤术后淋巴囊肿的临床应用价值。方法在经腹部超声引导下,对112例盆腔恶性肿瘤患者术后所形成的143个淋巴囊肿经皮穿刺置入8.5F Cook外引流管持续引流淋巴囊液。结果 143个淋巴囊肿均一步法一次成功穿刺并置入8.5F Cook外引流管,未出现与导管穿刺相关并发症。所有病灶均成功治疗,完全消失142例,治愈率达99.3%,仅1例于治疗3个月后复发,复发率不足1%。引流时间3~15 d,平均5 d。引流量270~3200 ml,平均812 ml。结论超声引导下经腹盆腔淋巴囊肿行穿刺置管治疗简单易行,患者痛苦小,并发症少,疗效确切,复发率低,安全性高,是盆腔淋巴囊肿的最佳治疗方法之一。     

超声引导介入治疗肝囊肿468例疗效评价

目的比较超声引导下无水乙醇的不同注射方法治疗肝囊肿的疗效。方法 468例肝囊肿患者,230例采用超声引导下囊肿穿刺抽液后注射无水乙醇治疗(传统组),238例采用超声引导下囊肿穿刺抽液后加无水乙醇灌洗治疗(灌洗组)。术后12个月内随访,观察疗效及并发症。结果 468例肝囊肿患者经无水乙醇治疗后12个月内复查,传统组治愈率为75.0%;灌洗组治愈率90.8%,两者之间有显著性差异(P<0.01)。两组>10.0cm肝囊肿治愈率无显著性差异(P>0.05),显效率有显著性差异(P<0.05)。结论超声引导下肝囊肿无水乙醇灌洗法是一种高疗效、疗程短、并发症少的方法。     

超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿

目的:探讨超声引导穿刺抽吸和/或置管引流治疗细菌性肝脓肿的临床应用价值。方法:对细菌性肝脓肿患者39例51个病灶实施超声引导下经皮穿刺,5cm的肝脓肿直接穿刺抽吸治疗,5cm的肝脓肿置管引流。结果:27例脓肿5cm者,1次抽吸治愈率85.2%(23/27),2次抽吸治愈率占14.8%(4/27)。12例脓肿5cm者行置管引流治疗,患者均在穿刺引流24～48h后体温降至正常,临床症状改善。结论:超声引导穿刺置管引流治疗细菌性肝脓肿安全、简便、有效,可作为临床治疗细菌性肝脓肿的首选方法。     

超声引导下经皮穿刺置管引流治疗胰腺假性囊肿16例分析

目的：探讨胰腺假性囊肿超声引导下经皮穿刺置管引流治疗的临床价值。方法：采用超声引导经皮穿刺治疗胰腺假性囊肿16例,其中单纯抽液1例,置管引流15例。结果：16例穿刺16次,共放入引流管15根,1例因囊腔与主胰管相通,改行开腹囊肿空肠Roux-Y吻合术,引流时间2周~6个月,临床治愈率96%,未见复发,无并发症。结论：超声引导下经皮穿刺置管引流治疗胰腺假性囊肿具有创伤小、疗效好、并发症少、可重复的优点,为临床提供了一种简便易行、疗效显著的微创治疗途径,可作为胰腺假性囊肿的首选治疗方法。     

普通超声探头引导经皮肝穿刺置管引流治疗肝脓肿

目的探讨普通超声探头引导经皮肝穿刺置管引流治疗肝脓肿的临床应用价值。方法对41例肝脓肿患者53个病灶行普通超声探头引导经皮肝穿刺置管引流术,直径〈50mm肝脓肿给予穿刺注药冲洗治疗,直径≥50mm肝脓肿行置管引流术。结果41例肝脓肿患者的53个病灶一次穿刺置管成功率100％,无并发症发生。穿刺置管抽液后患者体温即下降,有效率100％。2周治愈率达到65．9％,4周治愈率达到100％。结论利用普通探头引导进行穿刺置管引流治疗肝脓肿,具有安全有效、微创,费用低廉及操作简便、灵活的特点,值得推广应用：     

超声引导下经皮穿刺置管引流分别联合无水乙醇硬化与聚桂醇硬化治疗甲状腺囊肿的效果比较

目的 比较超声引导下经皮穿刺置管引流联合无水乙醇或聚桂醇硬化治疗甲状腺囊肿的效果。方法 回顾性分析濮阳市第三人民医院2017年9月至2019年8月167例甲状腺囊肿患者的临床资料,按治疗方案不同实施分组,将其中以超声引导下经皮穿刺置管引流联合无水乙醇硬化治疗的81例列为无水乙醇组,另外以超声引导下经皮穿刺置管引流联合聚桂醇硬化治疗的86例列为聚桂醇组。比较两组治疗后1个月、3个月、6个月、12个月囊肿体积缩小率、治疗前、治疗后3个月、6个月、12个月甲状腺功能及并发症发生率。结果 两组治疗后1个月、3个月、6个月、12个月囊肿体积缩小率比较,差异均未见统计学意义(P 0. 05);两组治疗后3个月、6个月、12个月血清游离三碘甲状原氨酸、游离甲状腺素、促甲状腺激素水平比较,差异均未见统计学意义(P0. 05);无水乙醇组并发症发生率为14. 81%(12/81),高于聚桂醇组[3. 49%(3/86)],差异有统计学意义(P 0. 05)。结论 超声引导下经皮穿刺置管引流联合无水乙醇或聚桂醇硬化治疗甲状腺囊肿效果均较为理想,且对甲状腺功能影响较小,但相较而言,采用聚桂醇硬化可明显降低并发症风险,应用价值更高。     

超声介入治疗盆腔恶性肿瘤术后盆腔淋巴囊肿18例临床观察

目的:探讨超声介入治疗盆腔恶性肿瘤术后盆腔淋巴囊肿的临床价值.方法:经腹彩色多普勒超声引导下通过穿刺抽液及无水乙醇硬化对18例盆腔恶性肿瘤术后21个症状性盆腔囊肿进行超声介入治疗.结果:18例21个囊腔均成功完成治疗.治愈16例(88.9%).好转2例(11.1%),治疗时患者局部感烧灼样疼痛1例,未经处理自行缓解,余无不良反应及并发症发生.结论:超声介入治疗盆腔恶性肿瘤术后盆腔淋巴囊肿安全、有效.     

超声引导介入治疗卵巢囊肿80例分析

目的分析超声引导下,对卵巢囊肿穿刺抽吸、无水乙醇反复冲洗硬化治疗的临床疗效。方法对80例卵巢囊肿,85个囊腔超声引导下穿刺抽尽囊液,用与抽出囊液25%量的无水乙醇反复冲洗1~3次硬化治疗。结果 85个囊腔均穿刺硬化治疗成功,有效率100%。结论超声引导介入治疗卵巢囊肿操作简便、安全、治愈率高,可以取得与手术相同或更好的疗效,值得临床推广应用。     

Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy.

OBJECTIVE: For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method. The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. METHODS: We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000. RESULTS: Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. CONCLUSIONS: Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy.     

Percutaneous management of breast abscesses. An experience of 39 cases

This is a review of our experience with percutaneous drainage by means of needle aspiration or catheter drainage of breast abscesses under ultrasound (US) guidance, and a suggested management algorithm. A retrospective study of the 39 patients (36 women, 3 men; mean age: 28.9 years) with breast abscesses who were treated by percutaneous US-guided procedures over a period of 13 years (1989 to 2002) was carried out. Of the 36 women, 34 were nonlactating and two lactating. Needle aspiration was used in the cases of fluid collections < or = 3 cm and catheter drainage in fluid collections of > 3 cm. Postdrainage care and US evolutive controls were carried out on an outpatient basis. Fine-needle aspiration cytology was performed in masses unresolved after postdrainage. Mammography was performed in patients over 30 years old. In all cases, US examination revealed images of fluid collection. A single needle aspiration was sufficient in 19 cases; 3 patients needed a second aspiration to resolve the breast abscess. A total of 15 cases were resolved by means of percutaneous catheter drainage. In 2 of the 17 patients who underwent catheter drainage, the mass persisted postdrainage; histologic findings showed a chronic abscess requiring surgical intervention in one and a breast carcinoma in the second. Mean follow-up was 8.4 months. Recurrence of breast abscess occurred in 4 patients, and these were resolved by surgical excision. Percutaneous drainage procedures in breast abscesses are a safe and effective alternative to incision and drainage. Needle aspiration is employed in cases of small abscesses and catheter drainage in abscesses larger than 3 cm. Although, in chronic abscesses, the treatment of choice is surgical excision, percutaneous drainage remains as an intermediate therapeutic option.     

超声引导下置管引流与穿刺抽吸在肝脓肿治疗中的比较

目的:比较超声引导下穿刺抽吸与置管引流在肝脓肿治疗中优劣。方法:33例置管引流与87例穿刺抽吸两组患者,术后比较体温及白细胞下降至正常的时间,平均住院时间以及并发症。两种方法均同时采用静脉内给抗生素治疗。结果:两组方法在疗效及安全性上无显著差异(包括体温及白细胞降至正常时间,平均住院时间以及并发症)。结论:超声引导下穿刺抽吸或置管引流在治疗肝脓肿的疗效与安全性均无显著差异。     

超声引导下穿刺治疗盆腔囊肿的应用价值

目的探讨彩色多普勒超声引导下进行盆腔囊肿穿刺的治疗效果。方法对73例盆腔囊肿患者行经腹部或经阴道超声引导下囊肿穿刺,抽液后部分行无水乙醇硬化囊壁治疗,所有囊液均送病理检查。结果 73例患者均一次性穿刺成功,无严重并发症发生。1例患者11个月后复发,另1例患者14个月后复发,均经二次穿刺治疗后痊愈;其余患者未见复发。结论彩色多普勒超声引导下经腹或经阴道穿刺抽液及无水乙醇硬化囊壁治疗盆腔囊肿是一种微创、简便易行、疗效肯定的治疗方法。     

Percutaneous drainage of pelvic abscesses: management of the tubo-ovarian abscess

Percutaneous drainage of 35 pelvic abscesses secondary to pelvic inflammatory salpingitis are reported. Two methods of drainage were used: simple aspiration and catheter drainage. The success rate of aspiration drainage was 94 per cent, while catheter drainage yielded a 77 per cent success rate. The differences between pelvic abscess drainage and other types of percutaneous drainage are presented. The role of percutaneous drainage in the treatment of pelvic inflammatory disease is also discussed.     

Management of transvaginal ultrasound-guided absolute ethanol sclerotherapy for ovarian endometriotic cysts

Purpose Endometriosis and endometriotic ovarian cysts are common gynecologic diseases. Excision of the cyst wall by laparotomy or laparoscopy is the standard treatment for endometriotic ovarian cysts. However, some young patients with cysts would prefer not to have an abdominal incision. We reviewed and assessed the effectiveness of transvaginal ultrasound-guided ethanol sclerotherapy in these patients. Methods Eighteen patients with endometriotic ovarian cysts underwent transvaginal ultrasound-guided aspiration and ethanol sclerotherapy using spinal anesthesia. The contents of the cysts were drained and sent for cytological examination. The cyst cavities were washed with absolute ethanol, and the cysts were then filled with absolute ethanol for 5 min. The patients were followed up with transvaginal ultrasonography. Results The transvaginal ethanol sclerotherapy was completed in all cases. The mean long diameter of the cysts was 50 mm (31–100 mm), and the mean operative duration was 22 min (8–45 min). Malignant cells were not isolated from the aspirated fluid in any case. There were no significant intra- or postoperative complications. Two patients (11.1%) had a recurrence at 3 and 32 months after ethanol sclerotherapy, respectively. Conclusions Transvaginal ultrasound-guided absolute ethanol sclerotherapy is useful for ovarian endometriotic cysts, particularly in young patients or in patients who would like to become pregnant. However, careful selection based on ultrasonography or magnetic resonance imaging findings and the age of the patients is critical. The substance of this study was presented in a speech given at the 78th Annual Scientific Meeting of the Japan Society of Ultrasonics in Medicine in Tokyo, Japan.     

Ultrasound-guided drainage of deep pelvic abscesses: experience with 33 cases

The aim of this study was to demonstrate and evaluate the ultrasound-guided drainage of deep pelvic abscesses in which transabdominal percutaneous access could not be performed because of overlying structures. A retrospective analysis of 32 consecutive patients with 33 deep pelvic abscesses was performed. The underlying causes of the abscesses included postsurgical fluid collection or surgical complications in 18 of the 32 patients, and 11 of these patients underwent recent rectal cancer surgery. The locations of the abscesses, which had a median diameter of 6 cm (range 2-10 cm), were as follows: perirectal (n = 13), presacral (n = 9), pouch of Douglas (n = 7), internal genitals (n = 2) and between the bowel loops (n = 2). The abscesses were all drained using ultrasound (US) guidance with a transrectal (n = 18), transvaginal (n = 11), transperineal (n = 2) or transgluteal (n = 2) approach. Of the larger abscesses (median diameter 7 cm), 19 were treated with catheter drainage and 18 of these cases resulted in favorable clinical outcomes. Of the smaller abscesses (median diameter 4 cm), 14 were treated with needle drainage. In two of these cases, follow-up US showed that a repeat puncture and drainage was necessary. All needle drainages resulted in favorable clinical outcomes. Sixteen of the 29 transrectal or transvaginal drainage procedures were performed without any anesthesia (10 were performed with a needle and six were performed with a catheter). Apart from minor discomfort during the drainage procedure and the subsequent in-dwelling catheter period, there were no serious complications related to the drainage procedures. We conclude that ultrasound-guided transrectal, transvaginal, transperineal and transgluteal drainage of deep pelvic abscesses are safe and effective treatment approaches. Based on our findings, needle drainage will be our most common first-line treatment approach because of the simplicity of the procedure, improved patient comfort and reduced costs. Catheter drainage will be reserved for large multiloculated abscesses.(E-mail: tlo@dadlnet.dk)     

超声引导下后入路骶前脓肿引流的临床应用

目的评价超声引导下后入路骶前脓肿置管引流的临床应用价值。 方法选取2013年6月至2015年12月在中山大学附属第六医院就诊的,经本院CT或磁共振成像（MRI）检查诊为骶前脓肿,并行超声引导下经臀大肌置管引流的48例患者。分析骶前脓肿形成的病因、位置、大小、形态、导管型号、引流时间,与导管相关疼痛和置管操作相关并发症的发生率,以及短期与长期疗效,引流管使用的型号分别为8F、10F、12F及16F,并且根据导管型号将病例分为4组,比较组间脓肿引流时间的差异,采用Kruskal-Wallis检验,脓肿体积与引流时间相关性采用Pearson检验。 结果骶前脓肿成因包括直肠癌术后吻合口瘘38例,先天性巨结肠术后3例,放射性直肠炎2例,直肠癌术后复发并肠穿孔1例,克罗恩病1例,阑尾炎并脓肿形成1例,直肠瘘1例,胰腺假性囊肿术后1例。脓肿最大直径为24~135 mm,体积为4.8~283.4 ml。引流管使用型号为8-16F,引流管留置时间为1~52 d（平均13 d）。42例（91.3%,42/46）患者骶前脓肿可充分引流无需进一步手术,有4例（8.7%,4/46）患者引流效果不佳需进一步手术治疗。8-16F不同型号引流管组间引流时间比较,差异均无统计学意义（P均>0.05）。脓肿体积与引流时间呈正相关（r=0.281,P<0.05）。经臀大肌置管引流术中及术后均无明显并发症。 结论超声引导下经臀大肌引流是一种安全、有效和易耐受的深部盆腔脓肿治疗方法,值得临床推广应用。     

Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach

Infected pelvic fluid collections are relatively common particularly after abdominal or pelvic surgery or in patients suffering from benign intestinal disease such as diverticulitis, appendicitis, or Crohn's disease. Historically the treatment of pelvic abscess has been either laparotomy with lavage or blind surgical incision and drainage through the rectal or vaginal wall. More recently, computed tomography and ultrasound-guided percutaneous drainage has become the procedure of choice, when feasible, for the treatment of pelvic abscess. However, many deep pelvic collections are not amenable to percutaneous technique. Transrectal or transvaginal ultrasound-guided abscess drainage is a safe and effective method used in the treatment of deep pelvic abscesses. The purpose of this article is to review the techniques, patient selection, pre- and post-procedural care, and monitoring aspects of transrectal or transvaginal ultrasound-guided drainage.     

超声引导经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤的临床应用

目的探讨超声引导下经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤的临床应用。 方法选取杭州市肿瘤医院2017年1月至2019年6月收治的症状性子宫肌瘤患者63例,所有患者均接受超声引导下经皮穿刺聚桂醇硬化治疗。分别于术前及术后1、3、6、12个月行常规超声和超声造影检查,测量瘤体体积,计算瘤体体积缩小率（FSR）并进行症状严重程度评分（SSS）。根据彩色多普勒血流成像分级将子宫肌瘤分为Ⅰ级、Ⅱ级和Ⅲ级供血组,根据子宫肌瘤术前肌瘤最大直径分为直径＜3 cm组、3~5 cm组和＞5 cm组,根据瘤体类型分为浆膜下肌瘤组、肌壁间肌瘤组和黏膜下肌瘤组,采用秩和检验比较不同瘤体血供组、瘤体大小组及瘤体类型组间的FSR的差异。 结果所有患者瘤体硬化治疗术后瘤体体积呈持续缩小趋势,术后1、3、6、12个月的FSR中位数分别为16.98%、51.69%、68.07%、80.83%。术后3、6、12个月SSS中位数较术前（中位数为28.13分）显著下降（中位数分别为21.88分,12.50分,9.38分）,差异有统计学意义（Z=-6.990、-9.035、-9.464,P均＜0.001）。各亚组间比较结果显示：Ⅲ级血供组、＞5 cm组肌瘤及浆膜下肌瘤组的FSR最低,Ⅲ级血供组FSR中位数为78.16%,＞5 cm组肌瘤FSR中位数为66.35%,浆膜下肌瘤组FSR中位数为76.97%。术中及术后出现无需治疗的不良反应者19例（30.1%,19/63）,无其他严重并发症发生。 结论超声引导下经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤创伤小、效果确切、并发症少,但对＞5 cm、血供丰富或浆膜下肌瘤疗效欠佳。