van Gansbeke D, Matos C, Gelin M, Müller P, Zalcman M, Devière J, Struyven J
Department of Radiology, Hôpital Erasme, Free University of Brussels, Belgium.
Br J Radiol. 1989 Feb;62(734):127-33. doi: 10.1259/0007-1285-62-734-127.
Forty subphrenic abscesses were drained percutaneously in 37 patients. These abscesses were subsequent to abdominal surgery (28 patients), biliary obstruction and/or fistula (six patients), trauma (two patients) or acute pancreatitis (one patient). The procedures were usually monitored by duplex sonography and fluoroscopy (35 out of 40 cases), with an angled subcostal approach to the subphrenic space in over 85% of the cases. Forty-three drainage catheters were inserted using the Seldinger method; 37 (86%) had a size of 12 F or more, 21 were 16 F in size. Only two out of 43 catheters were double-lumen sump drains. The clinical condition improved after insertion of the catheter in all 37 patients. Definitive successful drainage, defined as hospital discharge without complementary surgery, was achieved in 32 patients (87%), without major complications. A temporizing effect was obtained in three additional patients (8%) who underwent curative surgery for the underlying process after complete drainage of the abscess. Two patients died from multiple organ failure before their abscess healed. Considerations for successful drainage of subphrenic abscesses include a good knowledge of the subphrenic space anatomy, the use of large-bore drainage catheters and the recognition and correct management of underlying enteric, biliary or pancreatic fistulas.
对37例患者的40个膈下脓肿进行了经皮引流。这些脓肿继发于腹部手术（28例）、胆道梗阻和/或瘘（6例）、创伤（2例）或急性胰腺炎（1例）。操作通常采用双功超声和荧光透视监测（40例中的35例），超过85%的病例采用肋下斜角入路进入膈下间隙。采用Seldinger法插入43根引流导管；37根（86%）尺寸为12F或更大，21根尺寸为16F。43根导管中只有2根是双腔引流管。所有37例患者插入导管后临床状况均有改善。32例患者（87%）实现了明确的成功引流，即无需补充手术即可出院，且无重大并发症。另外3例患者（8%）在脓肿完全引流后接受了针对潜在病因的根治性手术，获得了暂时的效果。2例患者在脓肿愈合前死于多器官衰竭。成功引流膈下脓肿的注意事项包括对膈下间隙解剖结构的充分了解、使用大口径引流导管以及识别和正确处理潜在的肠瘘、胆瘘或胰瘘。
