超声引导下经皮穿刺抽脓治疗化脓性肝脓肿患者疗效及其对血清细胞因子水平的影响*

doi:10.3969/j.issn.1672-5069.2018.05.028

摘要/Abstract

摘要： 目的比较在超声引导下经皮肝穿刺抽脓与置管引流治疗化脓性肝脓肿（PLA）患者的疗效及其对血清细胞因子水平的影响。方法 2014年3月~2017年3月我院收治的78例PLA患者,采用随机数字表法将其分为观察组39例和对照组39例,分别采取在超声引导下经皮肝穿刺抽脓治疗或在超声引导下经皮肝穿刺置管引流治疗。采用ELISA法检测血清白介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）,采用荧光免疫法检测血清降钙素原水平。结果观察组脓腔消失时间为（9.0±0.9） d,显著短于对照组的（13.0±1.3） d（P<0.05）,而疼痛消失时间、体温正常时间、入院日和住院费用与对照组比,无显著性差异【分别为（1.3±0.1） d、（2.2±0.2） d、（12.3±1.3） d和（1.4±0.1）万元对（1.4±0.1） d、（2.3±0.3） d、（12.7±1.4） d和（1.4±0.1）万元,P>0.05】;两组治疗前后血生化指标变化无显著性统计学差异（P>0.05）;治疗后,观察组外周血白细胞数为（7.2±1.3）×10⁹/L,中性粒细胞比率为（0.7±0.1）,血清降钙素原水平为（0.3±0.1） ng/ml,与对照组的（8.7±1.5）×10⁹/L、（0.7±0.1）和（0.4±0.1） ng/ml比,无显著性统计学差异（P>0.05）;治疗后,观察组血清IL-6水平为（0.1±0.1） ng/ml,血清IL-8水平为（0.1±0.0）ng/ml,血清TNF-α水平为（0.2±0.0）μmol/L,与对照组的（0.1±0.0） ng/ml、（0.1±0.0） ng/ml和（0.2±0.1）μmol/L比,无显著性统计学差异（P>0.05）;术后,对照组分别有1例穿刺部位感染、出血和引流管脱落,两组并发症发生率比较,无显著性相差（P>0.05）。结论在超声引导下经皮肝穿刺抽脓或置管引流治疗PLA患者均能取得良好的疗效,但直接抽脓可能更有利于脓腔闭合,加速康复。临床医生应该以患者为中心,采取最直接有效的方法治疗。

关键词: 化脓性肝脓肿, 超声引导, 经皮穿刺, 疗效

Abstract: Objective To investigate the efficacy of ultrasound（US）-guided percutaneous aspiration in treatment of patients with purulent liver abscess（PLA） and its effects on blood cytokine levels. Methods 78 patients with PLA were recruited in our hospital between March 2014 and March 2017,and they were randomly divided into two groups by computer-generated numbers. The patients in observation group were treated by direct aspiration under US guidance,and those in the control were treated by percutaneous transhepatic catheter drainage under US guidance. Serum interleukin（IL）-6）,IL-8 and tumor necrosis factor-α（TNF-α） were detected by ELISA,and blood procalcitonin level was routinely assayed. Results The time of abscess disappearance in the observation was （9.0±0.9） d,much shorter than（13.0±1.3） d in the control （P<0.05）,while there were no significant differences between the two groups as respect to pain disappearance,temperature returned to normal,hospital stay and medical costs [（1.3±0.1） d,（2.2±0.2） d,（12.3±1.3） d and （14000±100） yuan vs. （1.4±0.1） d,（2.3±0.3） d,（12.7±1.4） d and （14000±100） yuan, respectively,P>0.05];there were no significant differences between the two groups as respect to blood biochemical parameters before and after the treatment （P>0.05）;in the observation group at the end of the treatment,peripheral blood white blood cell counts was（7.2±1.3）×10⁹/L,neutrophil ratio was（0.7±0.1） and serum procalcitonin level was（0.3±0.1） ng/ml,without significant difference as compared to （8.7±1.5）×10⁹/L,（0.7±0.1） and （0.4±0.1） ng/ml（P>0.05） in the control;serum IL-6 level was （0.1±0.1） ng/mL,IL-8 level was（0.1±0.0） ng/ml and TNF-α level was （0.2±0.0） μmol/L,without significant difference as compared to （0.1±0.0） ng/ml,（0.1±0.0） ng/ml and （0.2±0.1） μmol/L in the control （P>0.05）;the local infection occurred in one,bleeding in one and the drainage tube fell off in one in the control. Conclusion Ultrasound-guided percutaneous puncture aspiration in the treatment of patients with PLA have good clinical efficacy and safety.

Key words: Purulent liver abscess, Ultrasound-guidance, Percutaneous puncture, Efficacy

靳林上, 许冰. 超声引导下经皮穿刺抽脓治疗化脓性肝脓肿患者疗效及其对血清细胞因子水平的影响^*[J]. 实用肝脏病杂志, 2018, 21(5): 765-768.

Jin linshang, Xu Bin.. Ultrasound-guided percutaneous aspiration in treatment of patients with purulent liver abscess and its effects on blood cytokine levels[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 765-768.

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超声引导下经皮穿刺抽脓治疗化脓性肝脓肿患者疗效及其对血清细胞因子水平的影响^*

Ultrasound-guided percutaneous aspiration in treatment of patients with purulent liver abscess and its effects on blood cytokine levels

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