穿孔性阑尾炎所致脓肿：与经皮引流成功相关的因素
Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage.
作者信息
Fagenholz Peter J, Peev Miroslav P, Thabet Ashraf, Michailidou Maria, Chang Yuchiao, Mueller Peter R, Hahn Peter F, Velmahos George C
机构信息
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA.
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA.
出版信息
Am J Surg. 2016 Oct;212(4):794-798. doi: 10.1016/j.amjsurg.2015.07.017. Epub 2015 Oct 20.
BACKGROUND
Percutaneous drainage is the standard treatment for perforated appendicitis with abscess. We studied factors associated with complete resolution (CR) with percutaneous drainage alone.
METHODS
Ninety-eight patients underwent percutaneous drainage for acute appendicitis complicated by abscess (October 1990 to September 2010). CR was defined as clinical recovery, resolution of the abscess on imaging, and drain removal without recurrence. Patients achieving CR were compared with patients not achieving CR.
RESULTS
The rate of CR was 78.6% (n = 77). Abscess grade was the only radiological factor associated with CR (P = .007). The CR rate was higher with transgluteal drainage (90.9% vs 79.2%) than with other anatomic approaches (P = .018) and higher with computed tomography-guided drainage than with ultrasound-guided drainage (82.7% vs 64.3%, P = .046).
CONCLUSION
CR was more likely to be achieved in patients with lower abscess grade, computed tomography-guided drainage, and a transgluteal approach.
背景
经皮引流是治疗穿孔性阑尾炎伴脓肿的标准方法。我们研究了仅采用经皮引流实现完全缓解（CR）的相关因素。
方法
98例急性阑尾炎合并脓肿患者接受了经皮引流（1990年10月至2010年9月）。CR定义为临床康复、影像学检查脓肿消退且拔除引流管后无复发。将实现CR的患者与未实现CR的患者进行比较。
结果
CR率为78.6%（n = 77）。脓肿分级是与CR相关的唯一放射学因素（P = .007）。经臀引流的CR率（90.9%对79.2%）高于其他解剖学入路（P = .018），计算机断层扫描引导下引流的CR率高于超声引导下引流（82.7%对64.3%，P = .046）。
结论
脓肿分级较低、采用计算机断层扫描引导下引流以及经臀入路的患者更有可能实现CR。
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