CAJ | 학술논문

目的探讨超声引导经皮穿刺腹膜后囊性淋巴管瘤置管引流联合硬化治疗的临床疗效.方法收集我院治疗前通过超声和CT或MRI初步诊断为成人囊性淋巴管瘤患者27例.首先在超声引导下经皮活检囊壁组织送冰冻及进行囊液细胞学检查,证实为囊性淋巴管瘤后进行局部麻醉,然后在超声监视下经皮穿刺置入8.5F引流管行持续外引流;当引流量≤10 ml/24 h时,再注入聚桂醇注射液并保留,随后缓慢拔除引流管.观察其临床疗效,并就病变分隔数目对疗效的影响进行比较分析.结果 27例患者均一次穿刺置管成功,成功率100％;穿刺路径分别为前腹壁3例,侧腹壁7例,腰背部后腹膜入路17例.治愈22例,显效4例,好转1例,总有效率为100％;病变分隔越少,疗效越好(P值为0.010).2例患者发生囊壁出血,其余25例无漏液及感染等并发症发生.27例患者随访8～24个月,平均12个月.结论超声引导经皮穿刺置管引流联合聚桂醇注射液治疗腹膜后囊性淋巴管瘤创伤小,安全有效,并发症少,是一种疗效显著的微创治疗方法.
목적 탐토초성인도경피천자복막후낭성림파관류치관인류연합경화치료적림상료효.방법 수집아원치료전통과초성화CT혹MRI초보진단위성인낭성림파관류환자27례.수선재초성인도하경피활검낭벽조직송빙동급진행낭액세포학검사,증실위낭성림파관류후진행국부마취,연후재초성감시하경피천자치입8.5F인류관행지속외인류;당인류량≤10 ml/24 h시,재주입취계순주사액병보류,수후완만발제인류관.관찰기림상료효,병취병변분격수목대료효적영향진행비교분석.결과 27례환자균일차천자치관성공,성공솔100％;천자로경분별위전복벽3례,측복벽7례,요배부후복막입로17례.치유22례,현효4례,호전1례,총유효솔위100％;병변분격월소,료효월호(P치위0.010).2례환자발생낭벽출혈,기여25례무루액급감염등병발증발생.27례환자수방8～24개월,평균12개월.결론 초성인도경피천자치관인류연합취계순주사액치료복막후낭성림파관류창상소,안전유효,병발증소,시일충료효현저적미창치료방법.
Objective To evaluate the clinical curative effect of percutaneous tube drainage combined with sclerotherapy guided by ultrasound for treating the retroperitoneal cystic lymphatic tumor.Methods Twenty-seven adult cases with pathologically confirmed retroperitoneal cystic lymphatic tumor were collected from March 2009 to December 2012.All cases were initially diagnosed with retroperitoneal cystic lymphatic tumor by ultrasound,CT or MRI before treating.Firstly,the biopsy of the cyst wall tissues were conducted percutaneously guided by ultrasound for frozen section and the cystic fluid were conducted with the cytological examination.Then local anesthesia were conducted and the 8.5F drainage tube were implanted percutaneously by ultrasound-guided for continuous drainage after which was proved to be cystic lymphatic tumor.When the drainage volume≤10 ml/24 h,the lauromacrogol were injected and retained,and followed by the slow removal of drainage tube in order to observe its clinical curative effect,and analyzed the influence about the number of lesions on the curative effect of the separated comparative.Results All of the 27 patients successfully underwent percutaneous puncture catheter drainage for one time,the operation success rate was 100％.The puncture paths concluded:anterior abdominal approach (3 cases),lateral abdominal approach (7 cases) and retroperitoneal approach (17 cases).At last,22 cases were cured,4 cases were effective and 1 case was improved.The response rate was 100％,and the less partitions of the lesion,the better effect of the treatment(P =0.010).During the process,two patients bleed from the wall of the cyst when the wall was destructed and were controlled immediately after the intravenous injection of the hemostatic and intracapsular injection of lauromacrogol.No other complications occurred.All the 27 patients were followed up for 8 to 24 months(12 months for average).Conclusions The technique of percutaneous tube drainage combined with sclerotherapy guided by ultrasound for treating the retroperitoneal cystic lymphatic tumor is a safe,effective and minimally invasive treatment with small wound and less complications.