Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
J Vasc Interv Radiol. 2010 Mar;21(3):362-6. doi: 10.1016/j.jvir.2009.11.009.
Synthetic mesh has revolutionized abdominal wall hernia repair. However, mesh infections present a clinical problem because the standard practice of surgical excision is fraught with increased morbidity. Here, single-institutional outcomes in managing mesh-related collections via percutaneous drainage are retrospectively reviewed to assess its effectiveness.
A total of 21 patients underwent drainage of perimesh collections. Three types of mesh were employed: polytetrafluoroethylene (PTFE; n = 5), polypropylene (n = 14), and porcine dermal collagen (n = 3). One patient received both polypropylene and PTFE. Drainage was performed with ultrasound guidance (n = 19) or surgical drain exchange (n = 2). Mesh type, culture results, fluid collection size, and location were analyzed with respect to need for mesh excision.
Sixteen of 21 patients (76%) were successfully treated with drainage. One required additional surgical capsulectomy; the mesh was salvaged. Four required mesh excision because of recurrent infection (n = 2) or lack of improvement of clinical course (n = 2). Recurrent infection occurred in six patients, with mesh salvage via conservative management or new drainage in four. Fluid cultures were positive in 68% of patients (n = 13), with Staphylococcus aureus the most common organism. Cultures did not predict mesh excision (P = .26). The PTFE excision rate trended higher compared with polypropylene (40% vs 14%; P = .27). No porcine dermal collagen mesh was excised. Neither fluid collection size nor location predicted mesh excision. Mean follow-up was 319 days (range, 6-1,406 d).
Percutaneous drainage of suspected mesh-related abscess is effective. The use of PTFE mesh trended toward a higher excision rate.
合成网片彻底改变了腹壁疝修补术。然而，网片感染是一个临床难题，因为外科切除的标准操作存在更高的发病率。在此，我们回顾性分析了经皮引流治疗与网片相关脓肿的单中心结果，以评估其疗效。
共 21 例患者接受了网片周围脓肿的引流。使用了三种类型的网片：聚四氟乙烯（PTFE；n = 5）、聚丙烯（n = 14）和猪真皮胶原（n = 3）。1 例患者同时使用了聚丙烯和 PTFE。19 例行超声引导下引流，2 例行手术引流管更换。分析了网片类型、培养结果、积液大小和位置与网片切除的关系。
21 例患者中 16 例（76%）经引流成功治疗。1 例需要额外的手术包膜切除术；网片得以保留。4 例因反复感染（n = 2）或临床病程无改善（n = 2）而需要切除网片。6 例患者发生反复感染，其中 4 例通过保守治疗或新引流保留了网片。68%的患者（n = 13）的液体培养阳性，最常见的病原体是金黄色葡萄球菌。培养结果并不能预测网片切除（P =.26）。PTFE 网片切除率高于聚丙烯（40% vs 14%；P =.27）。未切除猪真皮胶原网片。积液大小和位置均不能预测网片切除。平均随访时间为 319 天（范围，6-1406 天）。
怀疑与网片相关的脓肿行经皮引流是有效的。使用 PTFE 网片切除率有升高的趋势。
