林东 林宁 陈圣 吴道明

[摘要] 目的 探讨超声引导下经皮穿刺置管引流联合抗生素治疗阑尾周围脓肿的安全性及可行性。 方法 回顾性分析福建省立医院和省立金山医院2015年1月～2018年1月收治的阑尾周围脓肿患者共156例，按治疗方式不同分为引流+抗生素组（引流组）和单纯抗生素治疗组（对照组），比较两组患者症状体征改善时间、白细胞计数恢复时间、抗生素使用时间、住院天数、并发症及治愈率、有效率等。 结果 引流组体温及白细胞计数恢复正常时间、抗生素使用时间、总住院天数均短于对照组，差异有统计学意义（P<0.05）；引流组中转手术3例，对照组中转手术4例，差异无统计学意义（P>0.05）；两组感染性休克、肠梗阻、肠瘘等并发症发生率比较差异无统计学意义（P>0.05）；引流组的治疗有效率和治愈率均高于对照组，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术联合治疗阑尾周围脓肿是安全可行的，患者恢复快、住院时间短，值得临床应用推广。

[关键词] 阑尾周围脓肿；超声引导；穿刺置管引流

[中图分类号] R656.8 [文献标识碼] B [文章编号] 1673-9701（2018）30-0116-04

[Abstract] Objective To investigate the safety and feasibility of ultrasound-guided percutaneous drainage combined with antibiotics in the treatment of abscess around the appendix. Methods 156 cases of abscess around the appendix admitted in Fujian Provincial Hospital and Fujian Provincial Jinshan Hospital from January 2015 to January 2018 were retrospectively analyzed. The patients were divided into drainage+antibiotic group（drainage group） and antibiotic treatment group（control group） according to different treatment methods. The improvement time of symptoms and signs， white blood cell count recovery time， antibiotic use time， hospitalization days， complications and cure rate， and efficiency between two groups were compared. Results The recovery time of temperature and white blood cell count， antibiotic use time and total hospitalization days of the drainage group were shorter than those of the control group， and the difference was statistically significant（P<0.05）. There were 3 cases of surgical intervention in the drainage group and 4 cases of surgical intervention in the control group. The difference was not statistically significant（P>0.05）. There was no significant difference in the complications rates of septic shock， intestinal obstruction and intestinal fistula between the two groups（P>0.05）. The effective rate and cure rate of the drainage group were higher than those of the control group， the difference was statistically significant（P<0.05）. Conclusion Ultrasound-guided percutaneous drainage and drainage is safe and feasible in the treatment of abscess around the appendix. The patient recovers quickly and the hospital stay is short. It is worthy of clinical application.

[Key words] Abscess around the appendix； Ultrasound guidance； Puncture drainage

急性阑尾炎的常见急腹症之一，其中约有3.8%的患者因阑尾炎症进展至坏疽、穿孔，炎性渗出被周边大网膜包裹、局限，进而形成阑尾周围脓肿[1]。虽然手术治疗治疗早期阑尾炎的疗效确切，但有证据表明，当阑尾周围脓肿形成后，由于局部炎症水肿、粘连严重，一期急诊手术难度较大，并且与并发症的风险显著相关，包括出血、肠瘘、肠梗阻、肠粘连、伤口感染等[2]，并存在治疗费用较贵、麻醉风险较大等缺点。随着影像和临床技术的发展，部分学者采用CT或超声引导下穿刺置管引流脓肿，连同抗生素治疗等方式也取得了满意的疗效[3]。因……