D'Agostino Horacio B, Hamidian Jahromi Alireza, Jafarimehr Elnaz, Johnson Patrick, Do Daniel, Henderson Benjamin, Chu Quyen, Shokouh-Amiri Hosein, Zibari Gazi
Department of Radiology and Surgery, Louisiana State University Health Sciences Center, Shreveport, USA.
J La State Med Soc. 2013 Mar-Apr;165(2):74-81.
There is a lack of technical guidelines for image-guided percutaneous drainage (IGPD) of pancreatic fluid collections (PFCs). To fill that void, we present a strategy and guidelines for systematic IGPD for effective PFCs evacuation.
Institutional Review Board (IRB)-approved study of 121 pancreatitis patients with symptomatic PFCs that underwent IGPD. IGPD strategy aimed at evacuation of the PFCs compartments using vigorous catheter drainage and manipulations. PFCs resolution and patients' outcome were measured.
Pancreatitis pathogenesis and etiology included: necrotizing, 79 patients (alcoholic, 40; biliary, 20; hyperlipidemia, 8; other, 11); traumatic, 32 patients; and chronic ductal, 10 patients (pseudocysts). An ipsilateral retroperitoneal access was used for pararenal spaces PFCs (61, 50% patients), a transabdominal IGPD approach for anterior PFCs (49 patients, 41%), an intercostal/subcostal access for left subphrenic PFCs (22 patients, 18%), and a transgastric drainage route for retrogastric PFCs (9 patients, 7%). Table 1 lists the site of the pancreatic fluid collections and number and size of the catheter(s) used for IGPD of the PFCs in the 121 patients. Fifty-seven (47%) patients had positive cultures PFCs. Of these, 24 (20%) had polymicrobial infections, and 18 (15%) had fungal infections. There were 20 (11%) patients with multi-compartment drainage. PFCs resolution occurred in 102 (84%) patients. PFCs recurrence was treated by surgery (four patients) or IGPD (one patient). Pancreatic fistulas closed, except in one patient. Nine patients (7%) experienced multiorgan failure/death; 5 (4%) were lost to follow-up.
目前缺乏针对胰腺液体积聚（PFCs）的影像引导下经皮引流（IGPD）的技术指南。为填补这一空白，我们提出了一种用于有效排空PFCs的系统性IGPD策略和指南。
经机构审查委员会（IRB）批准，对121例有症状PFCs且接受IGPD的胰腺炎患者进行研究。IGPD策略旨在通过积极的导管引流和操作来排空PFCs腔隙。测量PFCs的消退情况和患者的结局。
胰腺炎的发病机制和病因包括：坏死性，79例患者（酒精性，40例；胆源性，20例；高脂血症，8例；其他，11例）；创伤性，32例患者；慢性导管性，10例患者（假性囊肿）。肾旁间隙PFCs采用同侧腹膜后入路（61例，50%患者），前部PFCs采用经腹IGPD方法（49例患者，41%），左膈下PFCs采用肋间/肋下入路（22例患者，18%），胃后PFCs采用经胃引流途径（9例患者，7%）。表1列出了121例患者中胰腺液体积聚的部位以及用于PFCs的IGPD的导管数量和尺寸。57例（47%）患者的PFCs培养呈阳性。其中，24例（20%）有多种微生物感染，18例（15%）有真菌感染。20例（11%）患者进行了多腔引流。102例（84%）患者的PFCs消退。PFCs复发通过手术（4例患者）或IGPD（1例患者）治疗。除1例患者外，胰瘘均闭合。9例（7%）患者发生多器官功能衰竭/死亡；5例（4%）失访。
