Stabile B E, Puccio E, vanSonnenberg E, Neff C C
Department of Surgery, University of California, San Diego School of Medicine.
Am J Surg. 1990 Jan;159(1):99-104; discussion. doi: 10.1016/s0002-9610(05)80613-0.
To define the role of percutaneous catheter drainage in the initial management of diverticular abscess, we reviewed 19 patients who were followed for an average of 17.4 months after drainage. All patients had large paracolic or pelvic abscesses with a mean size of 8.9 cm. There were no complications related to catheter placement, and 15 patients (79 percent) required drainage for less than 3 weeks. Sepsis resolved rapidly, and only two patients (11 percent) had persistent fever or leukocytosis beyond the third day of drainage. Routine sinography revealed fistulous communications to the colon in nine patients (47 percent), but only three (16 percent) had grossly feculent drainage. Fourteen patients (74 percent) completed the treatment plan of preoperative catheter drainage followed by single-stage sigmoid colectomy and primary anastomosis without complications. Two patients refused operation, one of whom died 16 days postoperatively from recurrent sepsis and end-stage pulmonary disease. The three patients with fecal fistulas all had inadequate control of infection, suggesting the need for early operation and fecal diversion in such cases. We conclude that preoperative percutaneous catheter drainage obviates the need for colostomy and multiple-stage surgery in approximately three-fourths of patients with large diverticular abscesses.
为明确经皮导管引流在憩室脓肿初始治疗中的作用，我们回顾了19例患者，这些患者在引流后平均随访17.4个月。所有患者均有较大的结肠旁或盆腔脓肿，平均大小为8.9厘米。未发生与导管置入相关的并发症，15例患者（79%）引流时间少于3周。脓毒症迅速消退，只有2例患者（11%）在引流第三天后仍持续发热或白细胞增多。常规窦道造影显示9例患者（47%）与结肠存在瘘管相通，但只有3例（16%）有明显粪性引流。14例患者（74%）完成了术前导管引流的治疗计划，随后接受了一期乙状结肠切除术和一期吻合术，无并发症发生。2例患者拒绝手术，其中1例在术后16天因复发性脓毒症和终末期肺部疾病死亡。3例粪瘘患者感染均控制不佳，提示此类病例需要早期手术和粪便转流。我们得出结论，术前经皮导管引流可使约四分之三患有较大憩室脓肿的患者无需进行结肠造口术和多期手术。
