摘要
目的探讨超声引导下穿刺留置双管引流方法治疗咽旁间隙脓肿的可靠性与准确性。方法咽旁间隙脓肿单个直径≥6 cm为入选标准。穿刺前行常规超声及彩超定位,设定穿刺点,在人体皮肤上相应位置做标记,常规碘伏消毒,穿刺点用2%利多卡因5～10 mL局麻。先用1根10Fr的Skater引流套管针,穿刺至脓肿较深区域,退出针芯,留置套管,作为冲洗管。随后重复上法将另1根10Fr的Skater套管针穿刺至脓肿的较浅区域,两根针的远端间距3 cm,固定套管。取出针芯抽取脓液,作细菌培养及药敏试验。用注射器尽量抽吸脓液,然后用冲洗液（0.9%氯化钠注射液500 mL＋庆大霉素24万U和0.2%甲硝唑注射液250 mL）反复冲洗脓腔,2次/d,冲洗完毕接负压吸引装置。如脓液稠厚不易引流,可先用0.1%α-糜蛋白酶生理盐水25 mL注入脓腔,再抽脓后注入约20 mL 0.2%甲硝唑。待冲洗物变清亮,拔除套管。选用西力欣静脉滴注。结果超声引导下穿刺留置双引流管治疗咽旁间隙脓肿患者15例,脓肿直径6.0～6.8 cm。置管引流后48 h,发热减退或消失,治愈率达100%。结论超声引导下穿刺置双管引流治疗咽旁间隙脓肿安全可靠,疗效肯定,并发症少,是一种行之有效的治疗方法。
Objective To evaluate the reliability and effectiveness of double tube drainage under ultrasound-guided puncture in the treatment of parapharyngeal space abscess. Methods 15 patients,with single abscess in the parapharyngeal space and the diameter of abscess no less than 6 cm,were included into the study. Routine ultrasound and color Doppler were applied to locate the site for the puncture. After iodine disinfection and 2% lidocaine（ 5-10 mL） local anesthesia,A 10Fr＇s Skater drainage tracer was inserted into the deep side of the abscess,but the other one to a shallower side. The distance between the ends of two tubes was about 3cm. After removing the inner needle,the pus was extracted for bacterial culture and drug sensitive test. The rest of pus was pumped with a syringe as much as possible,and then rinse solution（ 500 mL of 0. 9% sodium chloride injection plus 240 000 units of gentamicin and 250 mL of 0. 2%metronidazole injection） was applied to irrigate abscess repeatedly. At the end of irrigation,a negative pressure suction device would be connected with the deeper tube. The above irrigation was performed twice a day. If the pus was too sticky to drain,25 mL of 0. 1% α-chymotrypsin saline solution would be injected into the abscess cavity,followed by approximately 20 mL of 0. 5% metronidazole. In this way,the tubes were not removed until the rinse solution became clear. All the patients were treated with intravenous cefuroxime. Results The fever dropped or disappeared after48-hour drainage. All of 15 patients were discharged with full recovery,and were followed up for six months without recurrence. Conclusion It is safe and reliable to drain the parapharyngeal space abscess with double tubes under ultrasound guide. Due to less complication and curative effects,it should be recommended.
出处
《山东大学耳鼻喉眼学报》
CAS
2014年第4期62-64,共3页
Journal of Otolaryngology and Ophthalmology of Shandong University
关键词
超声
咽旁间隙
引流
穿刺
脓肿
Ultrasonography
Parapharyngeal space
Drainage
Puncture
Abscess
