Téllez-Ávila Félix, Carmona-Aguilera Guillermo Jesús, Valdovinos-Andraca Francisco, Casasola-Sánchez Luis Eduardo, González-Aguirre Adrían, Casanova-Sánchez Ivan, Elizondo-Rivera Javier, Ramírez-Luna Miguel Ángel
Gastrointestinal Endoscopy Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
Imaging Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
Dig Endosc. 2015 Nov;27(7):762-6. doi: 10.1111/den.12475. Epub 2015 Apr 30.
Postoperative fluid collections (POFC) have high mortality. Percutaneous drainage (PD) is the preferred treatment modality. Drainage guided by endoscopic ultrasound (EUS-GD) represents a good alternative. The aim of the present study was to compare clinical success and complication rates of EUS-GD versus PD.
Data collected prospectively were analyzed in a retrospective manner. Patients with POFC from October 2008 to November 2013 were included. All collections were drained percutaneously or by EUS-GD.
Sixty-three procedures in 43 patients with POFC were analyzed; 13 patients were drained using EUS-GD and 32 patients with PD. Two patients assigned initially to the PD group were reassigned to EUS-GD. Surgery procedures most often related to the collections were intestinal reconnection, distal pancreatectomy, biliary-digestive bypass, and exploratory laparotomy. Technical success (100% vs 91%; P = 0.25), clinical success (100% vs 84%; P = 0.13), recurrence (31% vs 25%; P = 0.69), hospital stay days (median 22 vs 27; P = 0.35), total costs (8328 ± 1600 USD vs 11 047 ± 1206 USD; P = 0.21), complications (0% vs 6%; P = 0.3), and mortality (8% vs 6%; P = 0.9) were each evaluated in the EUS-GD and PD groups, respectively. In the PD group one death was related to the procedure.
EUS-GD is as effective and safe as PD in patients with POFC. The advantage of not requiring external drainage and a trend to higher clinical success and lower total costs must be considered.
术后积液（POFC）具有较高的死亡率。经皮引流（PD）是首选的治疗方式。内镜超声引导下引流（EUS - GD）是一种很好的替代方法。本研究的目的是比较EUS - GD与PD的临床成功率和并发症发生率。
对前瞻性收集的数据进行回顾性分析。纳入2008年10月至2013年11月患有POFC的患者。所有积液均通过经皮或EUS - GD进行引流。
分析了43例POFC患者的63次操作；13例患者采用EUS - GD引流，32例患者采用PD引流。最初分配到PD组的2例患者重新分配到EUS - GD组。与积液最常相关的手术操作是肠吻合术、胰体尾切除术、胆肠吻合术和剖腹探查术。分别在EUS - GD组和PD组中评估了技术成功率（100%对91%；P = 0.25）、临床成功率（100%对84%；P = 0.13）、复发率（31%对25%；P = 0.69）、住院天数（中位数22天对27天；P = 0.35）、总费用（8328±1600美元对11047±1206美元；P = 0.21）、并发症发生率（0%对6%；P = 0.3）和死亡率（8%对6%；P = 0.9）。在PD组中，有1例死亡与操作相关。
在POFC患者中，EUS - GD与PD一样有效且安全。必须考虑到EUS - GD无需外部引流的优势以及临床成功率较高和总费用较低的趋势。
