Robert Brice, Chivot C, Fuks D, Gondry-Jouet C, Regimbeau J M, Yzet T
Department of Digestive Radiology, Amiens North Hospital, University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
Abdom Imaging. 2013 Apr;38(2):285-9. doi: 10.1007/s00261-012-9917-z.
Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature.
We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome.
From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage.
When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).
经皮引流腹部和盆腔脓肿是手术的一线替代方法。前路和侧路受骨盆骨、肠管、膀胱和髂血管等障碍物的限制。本研究的目的是通过回顾我们的临床经验和文献，评估经皮经臀入路的可行性、安全性、耐受性和有效性。
我们回顾了30例行经皮计算机断层扫描（CT）引导下经臀引流患者的病历中的人口统计学、临床和形态学数据。特别是，我们研究了导管引流的持续时间、生物液体培养中的微生物类型、与操作相关的并发症以及患者的短期治疗结果。
2005年1月至2011年10月，我院345例患者接受了CT引导下经皮盆腔脓肿引流。30例采用经臀入路（10例女性，20例男性；平均年龄：52.6岁[范围14 - 88岁]）。26例患者（86.7%）的液体聚集与术后并发症有关，其余4例患者（急性憩室炎：n = 2；阑尾炎：n = 1；克罗恩病：n = 1）（13.3%）与腹腔内炎症或感染性疾病有关。平均引流持续时间为8.7天（范围3 - 33天）。27例患者（90%）实验室培养呈阳性，大肠杆菌是最常见的微生物（在77.8%的阳性样本中）。经梨状肌入路（n = 5）更常伴有术中即刻疼痛（n = ）。经臀手术期间或术后均未观察到重大并发症。29例患者（96.7%）引流成功。1例患者在引流14天后死于大面积急性脑卒。
当前路不可行时，经皮CT引导下经臀引流是一种安全、耐受性良好且有效的方法。重大并发症罕见。这种引流方式是治疗深部盆腔脓肿（尤其是术后积液）的手术替代方法。
