Kim Young Jun, Han Joon Koo, Lee Jeong Min, Kim Se Hyung, Lee Kyoung Ho, Park Seong Ho, An Su Kyung, Lee Jae Young, Choi Byung Ihn
Department of Diagnostic Radiology and Institute of Radiation Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Radiology. 2006 May;239(2):591-8. doi: 10.1148/radiol.2392050301. Epub 2006 Mar 28.
To retrospectively assess the effectiveness and safety of postoperative percutaneous drainage of abdominal abscesses with limited accessibility by using a preexisting surgical drain as an access route.
The study was approved by the institutional review board, and informed consent was not required. The authors reviewed the medical records of 92 patients (62 male, 30 female; median age, 59 years; age range, 3-79 years) with postoperative abdominal abscesses in whom percutaneous drainage was performed by using surgical drains as an access. Factors evaluated included the location and size of the lesion; time between surgery and the drainage procedure; distance between the lesion and surgical drain; presence of fistula; duration of drainage; type of surgical drain; size, type, and length of drainage catheter; and complications. Technical success was defined as adequate placement of a new drainage catheter into the target abscess. Midterm success was defined as avoidance of surgery or additional percutaneous drainage during the 6 months of follow-up. Univariate analysis and multiple logistic regression analysis were performed to determine factors that affected the technical or midterm success of the procedure.
Of 92 postoperative abscesses for which the technique was attempted, 56 (61%) had a subphrenic location and 36 (39%) had a peripancreatic location. Technical success was achieved in 87 of the 92 patients (95%). Technical success was not significantly associated with any of the factors tested. Midterm success was achieved in 75 of the 87 patients (86%) in whom technical success was achieved. Midterm failure showed a statistically significant relationship with the presence of fistula (P = .04). No procedure-related complications were identified.
Percutaneous drainage by using the surgical drain as an access route is an effective and safe alternative for draining postoperative abdominal abscesses that are less accessible with direct puncture..
回顾性评估利用预先存在的外科引流管作为入路途径对难以触及的腹部脓肿进行术后经皮引流的有效性和安全性。
本研究经机构审查委员会批准，无需知情同意。作者回顾了92例术后腹部脓肿患者（62例男性，30例女性；中位年龄59岁；年龄范围3 - 79岁）的病历，这些患者通过使用外科引流管作为入路进行了经皮引流。评估的因素包括病变的位置和大小；手术与引流操作之间的时间；病变与外科引流管之间的距离；瘘管的存在；引流持续时间；外科引流管的类型；引流导管的尺寸、类型和长度；以及并发症。技术成功定义为将新的引流导管充分置入目标脓肿。中期成功定义为在6个月的随访期间避免手术或再次经皮引流。进行单因素分析和多因素逻辑回归分析以确定影响该操作技术或中期成功的因素。
在尝试该技术的92例术后脓肿中，56例（61%）位于膈下，36例（39%）位于胰周。92例患者中有87例（95%）实现了技术成功。技术成功与所测试的任何因素均无显著相关性。在实现技术成功的87例患者中，75例（86%）实现了中期成功。中期失败与瘘管的存在具有统计学显著相关性（P = 0.04）。未发现与操作相关的并发症。
利用外科引流管作为入路途径进行经皮引流是一种有效且安全的替代方法，可用于引流直接穿刺难以触及的术后腹部脓肿。
