CT引导下经皮穿刺硬化剂治疗肝肾囊肿18例临床分析.docVIP

CT引导下经皮穿刺硬化剂治疗肝肾囊肿18例临床分析 贾建文 （长治医学院 影像本科7班 2014030210720） ［摘要］ 目的 探讨CT 引导经皮穿刺肝、肾囊肿硬化剂治疗的价值。方法 所有患者均经CT 平扫+增强扫描确诊为单纯性肝、肾囊肿， 在CT 引导定位经皮穿刺肝、肾囊肿内，抽出少量囊液送病检，用1%的利多卡因行囊腔麻醉后，抽净囊液，注入无水乙醇，术后分别于3 月和6 月复查CT 扫描对比．结果 随访18 例，16（84.6%）例治愈，2（15.4%）例显效，有效率100%．无严重并发症发生．结论CT 引导下经皮穿刺肾囊肿硬化剂治疗安全有效、准确性高、并发症低，能达到使囊肿缩小以至消失的治疗效果． ［关键词］ X线计算机；体层摄影术；经皮穿刺；CT 引导；肝肾囊肿；无水乙醇；硬化剂治疗 ［Abstract］ Objective To investigate the methods and efficacy of CT-guided percutaneous sclerotherapy forthe treatment of liver and kidney cyst. Methods The patients were confirmed by CT scan and enhanced scan diagnosed as simple hepatic or kidney cyst. They were treated with CT-guided percutaneous positioning liver andkidney cyst，and then a small amount of cyst fluid extract was sent to pathological examination. After anesthesia with 1% lidocaine CT scan was conducted respectively after operation for three or six months．Results The follow-up cases， liver and kidney cysts occured in cases，among which cysts were eliminated， and the cure rate was 00%.with the efficiency of 84.6%. there were no serious complications in the remaining cases．Conclusion CT-guided percutaneous kidney cyst sclerotherapy was safety，effective， high accuracy and low complication， which could achieve narrow therapeutic effect as well as cystsdisappear. ［Key words］X-ray computed; tomography; percutaneous puncture; CT-guided；Liver and kidney cyst；Ethanol；Sclerotherapy 肾囊肿经皮穿刺于1939 年Dean 首先报道，1980 年运用CT 扫描引导穿刺，1981 年Bean 报道29 例肾囊肿穿刺硬化剂治疗经过[1]． 近年来，随着影像检查技术的应用日益广泛，肝、肾囊肿的检出率较前明显提高．由于各种穿刺技术完善，使得肝、肾囊肿的外科治疗逐步被穿刺硬化术所代替， 成为肝、肾囊肿的常用治疗技术[2，3] １　材料与方法 1.1　一般资料 收集在Ｂ超或ＣＴ检查出肝、肾囊肿18例患者，男10例，女8例，年龄35～69岁，平均年龄42.3岁。其中肝囊肿2例，肾囊肝16例部分。囊肿最大者为9.2*8.5cm，最小者为4.0*3.8cm。肝囊肿患者有腹胀、肾囊肿多为腰部胀痛等不适等。在硬化治疗前均先行ＣＴ增强扫描，了解肾囊肿与肾盂、肾盏、输尿管的关系，肝囊肿了解与胆总管、血管的关系，明确手术方案。全部患者签署知情同意书、术前检查血尿常规、肝、肾功能、碘过敏实验、排除凝血障碍、酒精过敏史、精神紧张者给予镇静剂。 1.2设备与方法 引导设备采用东芝AUKLET2000螺旋CT机，，经皮酒精疗法针（规格为18-２2Ｇ*200mm）。患者采取仰卧、侧卧或者俯卧位，训练患者平静呼吸和平静呼吸后屏气，在进针点表面区域纵向放置金属栅格定位尺，确定囊肿最大层面，选择好最佳进针点，测出进针方向、角度和深度。退出检查床到合适位置，对进针部位常规消