Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Ellison 237, Boston, MA 02114, USA.
AJR Am J Roentgenol. 2010 Mar;194(3):815-20. doi: 10.2214/AJR.09.3282.
The purposes of this study were to determine the frequency with which percutaneous abdominopelvic abscess drainage catheters must be replaced because of inadequate drainage, to assess the effect of percutaneous catheter exchange on clinical outcome, and to determine the predictors of clinical success after catheter exchange.
A database of interventional radiology procedures performed at a single tertiary care hospital from 2001 to 2006 was searched to identify the cases of patients who underwent percutaneous catheter drainage of abdominal or pelvic abscesses that was followed by exchange of the drainage catheter at a later date. The electronic medical records and imaging studies of these patients were retrospectively reviewed to determine the abscess characteristics, details of drainage catheter manipulation, and clinical outcome.
Among the 3,027 percutaneous abscess drainage catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of undrained fluid and persistent fever and leukocytosis), for an overall frequency of catheter exchange of 2.7% of abscesses in 3.7% of patients. The success rate of catheter replacement, defined as resolution of the fluid collection without open surgical drainage, was 76.8% (63/82). Prognostic factors favorably influencing the clinical success of catheter exchange included a larger number of drainage catheter sideholes, absence of a fistula, low residual abscess volume after initial catheter drainage, and low CT attenuation of abscess fluid.
In cases of persistent abscess despite adequate catheter placement, percutaneous catheter exchange over a wire is useful for salvage after the large majority of primary failures. In addition, performance of CT and fluoroscopic catheter injection before catheter exchange facilitates recognition of the predictors of a likely response to catheter exchange.
本研究旨在确定经皮腹腔盆腔脓肿引流导管因引流不足而需要更换的频率，评估经皮导管更换对临床结果的影响，并确定导管更换后临床成功的预测因素。
检索 2001 年至 2006 年在一家三级保健医院进行的介入放射学程序数据库，以确定接受经皮导管引流腹部或盆腔脓肿且随后在以后日期更换引流导管的患者的病例。回顾性分析这些患者的电子病历和影像学研究，以确定脓肿特征、引流导管操作的详细信息和临床结果。
在放置的 3027 根经皮脓肿引流导管中，有 82 根因缺乏改善（影像学证据表明未引流的液体和持续发热和白细胞增多）而更换，总体脓肿更换频率为 3.7%的患者中有 2.7%。导管更换的成功率定义为在无需开放手术引流的情况下解决积液，为 76.8%（63/82）。有利于导管更换临床成功的预测因素包括引流导管侧孔数量较多、无瘘管、初始导管引流后脓肿残余量低和脓肿液 CT 衰减低。
在大量原发性失败后，即使导管放置充分，对于持续存在的脓肿，经皮导管更换是一种有用的挽救方法。此外，在导管更换前进行 CT 和荧光透视导管注射有助于识别导管更换可能反应的预测因素。
