关键词: 难治性肝脓肿, 介入栓塞, PTCD, 经皮肾镜, 微创

Abstract: Objective To investigate the application of percutaneous transhepatic cholangial drainage sequential percutaneous nephroscope in the treatment of refractory liver abscess after hepatic artery intervention. Methods Retrospective analysis of 5 patients with refractory hepatic abscess after transcatheter arterial chemoembolization (TACE) in our hospital from January 2018 to March 2021 (a case of hepatic abscess caused by TACE in hepatic metastases after pancreaticoduodenectomy, a case of hepatic abscess caused by repeated TACE for massive hepatocellular carcinoma, two cases of hepatic abscess caused by TACE for traumatic hepatic rupture, a case of liver abscess after interventional treatment of metastatic tumor in right lobe of liver after operation of colon cancer). We reviewed the effect of refractory liver abscess by PTCD and sequential percutaneous nephroscope. Results Blood routine, procalcitonin, liver and kidney function, coagulation, blood culture and abdominal enhanced CT were performed in all 5 patients, combined with the clinical manifestations, and the diagnosis of liver abscess was clear. Conventional interventional ultrasound or CT guided puncture catheter irrigation and drainage, combined with sensitive antibiotics anti-infection treatment, the curative effect was not good. Then sequential percutaneous nephroscope was used to remove the necrotic tissue of liver abscess and drainage, 5 cases of refractory liver abscess were cured, the effect was good. Conclusion In view of the refractory liver abscess after interventional operation, when the effect of irrigation and drainage by puncture and catheter is not good, and it is unable or difficult to tolerate surgical operation, PTCD sequential percutaneous nephroscope is an effective alternative for the treatment of liver abscess necrosis tissue removal and drainage.

Key words: Refractory liver abscess, Interventional embolization, PTCD, Percutaneous nephroscope, Minimal invasive