Cinat Marianne E, Wilson Samuel E, Din Adnan M
Department of Surgery, University of California, Irvine Medical Center, 101 City Dr, Bldg 53, Rte 81, Orange, CA 92868, USA.
Arch Surg. 2002 Jul;137(7):845-9. doi: 10.1001/archsurg.137.7.845.
Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD).
We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome.
The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome.
Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.
腹腔内脓肿的特征可用于预测经皮导管引流（PCD）的成功结果。
我们对接受PCD和静脉抗生素治疗的腹腔内感染患者进行了一项多中心前瞻性研究。多变量回归分析确定了成功结果的预测因素。
该研究纳入了96例患者（59%为男性；平均±标准差年龄，48±17岁；平均±标准差急性生理与慢性健康状况评分II，7.4±4.9）。53%的患者存在术后脓肿。分离出的微生物包括拟杆菌属（17%）、大肠杆菌（17%）、链球菌属（14%）、肠球菌属（10%）和真菌（11%）。83%的患者存在单个脓肿。80%的患者采用计算机断层扫描引导引流，20%采用超声引导。64%的患者脓肿引流持续时间少于14天。67例患者（70%）单次PCD治疗后感染完全消退，12例患者（12%）再次尝试后消退。33例患者（34%）在择期确定性手术前进行PCD以解决腹腔内脓毒症。15例患者（16%）因PCD失败需要开放引流，酵母菌感染患者（P<0.001）或胰腺病变患者（P = 0.02）更有可能出现这种情况。术后脓肿（P = 0.04）是成功结果的独立预测因素。
腹腔内感染的经皮导管引流对70%的患者单次治疗有效，再次尝试后有效率增至82%。术后脓肿、非胰腺脓肿且未感染酵母菌的情况下最有可能获得成功结果。经皮导管引流现在是纠正手术前解决腹腔内脓毒症的常用分期方法。
