Transthoracic liver abscess incision and drainage

Applicable to the abscess on the posterior side of the right lobe. Treatment of diseases: liver abscess amoebic liver abscess Indication 1. A bacterial liver abscess with a large abscess. 2. Amoebic liver abscess secondary infection or non-surgical treatment is invalid. 3. Hepatic cysticercosis secondary infection. Contraindications Coagulone dysfunction. Preoperative preparation 1. Full support for treatment: a small amount, multiple blood transfusions, fluid replacement, correction of water and electricity balance disorders and hypoproteinemia. 2. Anti-infective treatment: According to the determination of bacterial sensitivity, the pathogenic strain is estimated, sensitive antibiotics are selected or combined with broad-spectrum antibiotics. 3. Positioning: In order to further confirm the diagnosis and determine the surgical approach, the abscess can be determined according to physical signs, ultrasound, X-ray or liver abscess test puncture. Generally, tenderness, edema of the lower chest wall, and tenderness of the intercostal space are often abscesses. Surgical procedure The patient was placed in the left lateral position and anesthetized with general anesthesia or intercostal block. The incision was made obliquely between the right seventh, eighth or eighth and eighth intercostal ribs. The skin, subcutaneous tissue and rib periosteum were dissected, and the ribs were separated and removed. 3 to 5 cm, cut the costal bed, check the pleural horn pleural for adhesion. 1. If the pleura has been adhered: the puncture can be tested, and after the pus is withdrawn, the hemostatic forceps is used to enlarge the drainage port, the pus is sucked out, and the hose is drained. 2. If the pleura is not sticky: (1) Dry gauze or iodoform gauze in the wound, make the rib angle adhere to the pleura, take out the gauze after 3 days, and then test the puncture and cut the drainage. (2) It is also possible to push the pleura upwards, cut the diaphragm, and suture the diaphragm and the ribbed bed for 2 to 3 needles, and then perform a liver abscess test puncture, drainage and placement of the drainage tube. If the symptoms of systemic toxemia are severe, if you need to open the drainage of liver abscess in the second stage, you can take out the dry gauze or iodoform gauze, puncture the pus to temporarily improve the condition, and then fill the incision with dry gauze or iodoform gauze. . complication Respiratory failure.