Akhan Okan, Ozkan Orhan, Akinci Devrim, Hassan Abdulla, Ozmen Mustafa
Department of Radiology, Hacetttepe University School of Medicine, Ankara, Turkey.
Diagn Interv Radiol. 2007 Dec;13(4):204-9.
To evaluate the safety and efficacy of image-guided drainage of infected pleural effusions.
The clinical outcomes of 93 patients who underwent image-guided drainage of infected pleural effusions between 1998 and 2003 were retrospectively analyzed. Among the 93 patients, 31 (33.3%) were younger than 16 years of age. In all, 129 catheters (8F-14F pigtail catheters) were placed under ultrasonography (US) or computed tomography guidance. In 27 patients (29.0%) intracavitary fibrinolytic therapy with streptokinase was employed to improve drainage. The patients were followed up during daily rounds and, when drainage problems occurred, catheters were exchanged or repositioned. New catheters were placed for undrained loculations.
The success, failure, and recurrence rates were 92.5% (86/93), 7.5% (7/93), and 6.4% (6/93), respectively. In the pediatric age group the success rate was significantly higher. Intracavitary fibrinolytic therapy significantly improved daily output, but did not significantly reduce drainage duration or hospital stay. There was no significant difference between the successful and failed treatment cases in terms of US findings, gross appearance, or culture positivity. The only major complication was anaphylactic reaction due to intracavitary instillation of streptokinase (n = 1, 1.1%). The 30-day mortality rate was 2%.
Image-guided catheter drainage of infected pleural collections is a safe and effective method. Addition of intracavitary fibrinolytic instillation improves drainage, but early intervention prior to collections becoming more complicated remains an important factor in determining prognosis. Non-loculated anechoic collections without septa have a high probability of favorable outcome.
评估影像引导下感染性胸腔积液引流的安全性和有效性。
回顾性分析1998年至2003年间93例行影像引导下感染性胸腔积液引流患者的临床结局。93例患者中，31例（33.3%）年龄小于16岁。总共在超声（US）或计算机断层扫描引导下放置了129根导管（8F - 14F猪尾导管）。27例患者（29.0%）采用链激酶进行腔内纤维蛋白溶解治疗以改善引流。在日常查房时对患者进行随访，当出现引流问题时，更换或重新放置导管。对于未引流的分隔腔隙放置新的导管。
成功率、失败率和复发率分别为92.5%（86/93）、7.5%（7/93）和6.4%（6/93）。在儿童年龄组中成功率显著更高。腔内纤维蛋白溶解治疗显著提高了每日引流量，但未显著缩短引流持续时间或住院时间。在超声检查结果、大体外观或培养阳性方面，成功和失败治疗病例之间无显著差异。唯一的主要并发症是腔内注入链激酶引起的过敏反应（n = 1，1.1%）。30天死亡率为2%。
影像引导下感染性胸腔积液置管引流是一种安全有效的方法。腔内注入纤维蛋白溶解剂可改善引流，但在积液变得更复杂之前进行早期干预仍然是决定预后的重要因素。无分隔的无回声积液有较高的良好预后可能性。
