探讨经皮穿刺双置管引流在细菌性肝脓肿自发性破裂中的应用价值。

回顾性分析2001年6月至2015年12月在佛山市第一人民医院行经皮穿刺双置管引流治疗的9例细菌性肝脓肿自发性破裂患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男7例，女2例；年龄38～66岁，中位年龄51岁。6例发生在肝左叶，3例肝右后叶；脓肿破裂导致膈下脓肿5例，肝左外叶-胃间隙脓肿2例，右侧膈下-右侧结肠旁沟脓肿2例；均采用经皮肝内脓肿及肝周腹腔脓肿双置管引流治疗，联合应用敏感抗生素。

9例肝内脓肿均于超声引导下经皮穿刺置入1条8 F引流管，8例肝周腹腔脓肿各置入1条10 F引流管，1例患者肝周腹腔脓肿置入2条10 F引流管。肝内脓肿引流管平均放置时间（14.2±3.9）d，肝周腹腔脓肿引流管放置时间（5.0±0.7）d。9例患者均成功治愈，随访6个月，无腹腔脓肿、肠粘连等并发症发生。

经皮穿刺双置管引流治疗细菌性肝脓肿自发性破裂简便、安全、可行，避免了开腹或腹腔镜手术，具有微创优势，尤其适用于腹腔脓肿局限者。

To evaluate the application of percutaneous double-catheter drainage in treatment of spontaneous rupture of bacterial liver abscess.

Clinical data of 9 patients with spontaneous rupture of bacterial liver abscess treated by percutaneous double-catheter drainage in the First People's Hospital of Foshan from June 2001 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 were male and 2 female, aged 38-66 years with a median age of 51 years. The rupture occurred in the left lobe of 6 patients and in the right posterior lobe of 3 cases. Subphrenic abscess caused by the abscess rupture was observed in 5 cases, left lateral lobe-gastric abscess in 2 cases, and right subphrenic-right paracolic sulci abscess in 2 cases. All patients were treated with percutaneous double-catheter drainage combined with sensitive antibiotics for intrahepatic abscess and perihepatic abdominal abscess.

All the 9 cases of intrahepatic abscess received placement of a 8 F catheter guided by ultrasound, 8 cases of perihepatic abdominal abscess received placement of a 10 F catheter, and 1 case of perihepatic abdominal abscess received placement of 2 10 F catheters. The average time of placement for intrahepatic abscess patients was (14.2±3.9) d, and (5.0±0.7) d for perihepatic abdominal abscess patients. All 9 patients were cured successfully. All patients were followed up for 6 months without postoperative complications, such as abdominal abscess and intestinal adhesion, etc.

Percutaneous double-catheter drainage is a convenient, safe and feasible method for spontaneous rupture of bacterial liver abscess, which avoids laparotomy or laparoscopic surgery and has advantage of minimal invasion, especially suitable for the patients with limited abdominal abscess.