Ballard David H, Hamidian Jahromi Alireza, Li Anna Y, Vea Romulo, Ahuja Chaitanya, D'Agostino Horacio B
School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
Department of Surgery Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
J Vasc Interv Radiol. 2015 Sep;26(9):1363-7. doi: 10.1016/j.jvir.2015.06.030.
To describe a systematic catheter management approach for treatment of abscesses with enteric fistulae by abscess evacuation and selective fistula tract cannulation in a series of patients with postprocedural abscess-fistula complexes.
This single-center retrospective study included 27 patients (17 male; mean age, 51.3 y) who underwent percutaneous drainage of postprocedural abscess-fistula complexes from January 2005 to September 2013. There were 15 low-output and 12 high-output fistulae. Intra-abdominal abscesses were evacuated by percutaneous drainage. Multiple catheters were used for collections with viscous fluid or size ≥ 6 cm in diameter. High-output fistulae and recurrent low-output fistulae had additional catheter cannulation of the enteric hole to facilitate the creation of a controlled enterocutaneous tract. There was no preexisting cutaneous tract before catheter insertion in 23 fistulae.
Abscess-fistula complex resolution occurred in 24 patients (88.9%). Of the 3 cases of failure, 2 patients required surgical repair of the fistula, and 1 patient died. Mean number of drainage procedures was 7.0, and mean catheter duration was 76.1 days. There was no significant difference in catheter duration of low-output and high-output abscess-fistula complexes (P = .34); however, high-output patients underwent significantly more procedures (9.1 vs 6.1, P = .025). There were 15 fistulae that were cannulated (11 high-output and 4 low-output fistulae). Cannulated abscess-fistula complexes had significantly longer catheter duration (102.5 d vs 53.2 d, P = .04) and underwent significantly more procedures (8.4 vs 5.4, P = .04).
The catheter management strategy was successful in resolving most abscess-fistula complexes in this series.
描述一种系统性导管管理方法，用于通过脓肿引流和选择性瘘管插管治疗一系列术后脓肿-瘘管复合体患者的肠瘘性脓肿。
这项单中心回顾性研究纳入了2005年1月至2013年9月期间接受经皮引流术后脓肿-瘘管复合体的27例患者（17例男性；平均年龄51.3岁）。有15例低流量瘘管和12例高流量瘘管。经皮引流清除腹腔内脓肿。对于粘性液体或直径≥6 cm的积液，使用多根导管。高流量瘘管和复发性低流量瘘管对肠瘘口进行额外的导管插管，以促进可控肠造口通道的形成。23例瘘管在导管插入前无预先存在的皮肤通道。
24例患者（88.9%）的脓肿-瘘管复合体得到解决。在3例失败病例中，2例患者需要进行瘘管手术修复，1例患者死亡。平均引流次数为7.0次，平均导管留置时间为76.1天。低流量和高流量脓肿-瘘管复合体的导管留置时间无显著差异（P = 0.34）；然而，高流量患者接受的操作明显更多（9.1次对6.1次，P = 0.025）。有15例瘘管进行了插管（11例高流量瘘管和4例低流量瘘管）。插管的脓肿-瘘管复合体的导管留置时间明显更长（102.5天对53.2天，P = 0.04），且接受的操作明显更多（8.4次对5.4次，P = 0.04）。
在本系列中，导管管理策略成功解决了大多数脓肿-瘘管复合体。
