Flancbaum L, Nosher J L, Brolin R E
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick.
Am Surg. 1990 Jan;56(1):52-6.
Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.
放射学定位技术的改进已使经皮导管引流术（PCD）成为许多腹腔内脓肿（IAA）的首选初始治疗方法。在过去七年中，154例患者接受了PCD治疗腹腔脓肿。其中14例患者将PCD作为继发于脏器穿孔的IAA的初始治疗方法，随后接受了择期一期手术以治疗基础疾病。脓肿的病因包括6例穿孔性阑尾炎、3例乙状结肠憩室炎、2例克罗恩回肠炎，以及各1例胃溃疡穿孔、乙状结肠癌穿孔和胆囊穿孔。脓肿的初始定位通过CT或超声完成。7个脓肿位于右下腹，4个位于肝脏，左腰部、右腰部、肝下间隙和盆腔各有1个。所有患者随后均接受了针对其原发性疾病的确定性择期手术，包括6例间隔期阑尾切除术、4例乙状结肠切除术、2例小肠切除术、1例胃大部切除术和1例胆囊切除术。PCD未引起并发症，也未发生死亡。我们得出结论，PCD可成功作为与脏器穿孔相关的IAA的初始治疗方法，从而避免了传统两阶段手术方法的第一阶段。
