Okhotnikov O I, Yakovleva M V, Shevchenko N I, Grigoriyev S N, Pakhomov V I
Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia.
Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia; Chair of Surgical Diseases of Kursk State Medical University, Healthcare Ministry of the Russian Federation, Kursk, Russia.
Khirurgiia (Mosk). 2018(6):35-40. doi: 10.17116/hirurgia2018635-40.
Show the possibility of an alternative use of interventional radiology techniques in complex treatment of patients with inflammatory complications of the diverticular disease of the colon.
In 2012-2016, there were 87 patients under our supervision with complicated diverticular disease. In 57 (65.5%) cases were diagnosed infiltrate, in 24 (27.6%) cases - abscess of paracolon area (Ib-II type by Hinchey), in 6 (6.9%) cases (III-IV type according Hinchey) generalized peritonitis have been identified.
Emergency laparotomy was performed in 13 patients. Abscesses of paracolon (Ib-II type by Hinchey) area were diagnosed sonographically during the initial examination in 17 patients. 26 percutaneous drainage of diverticulogenous abscesses of different localizations self-locking drainage #8Fr 'pig tail' was carried out under the combined ultrasonic and X-ray control in this group of patients. The technical success of percutaneous drainaging of the abscesses was achieved in all manipulations. 13 patients had a single drainaging, and for diverticular disease - disease-free during the observation period of 1 year to 5 years. Resection of the colon in a planned manner after percutaneous drainage of recurrent abscess of paracolon area was performed in 4 patients. Complications related with the technique of installing drainage were not reported, mortality in the group of drained patients was absent.
Ultrasound examination of patients with suspected inflammatory complications of diverticular disease - a necessary and sufficient method for initial diagnosis of the disease. Percutaneous drainage of diverticulogenous abscesses (Hinchey Ib-II) is represented by the pragmatic 'first line' choice in patients with complicated diverticular disease, that allows to treat the pathology steadfastly in most of the cases.
展示介入放射学技术在结肠憩室病炎症并发症患者复杂治疗中的替代应用可能性。
2012年至2016年，我们对87例患有复杂憩室病的患者进行了监测。57例（65.5%）诊断为浸润，24例（27.6%）为结肠旁区域脓肿（根据欣奇分类为Ib-II型），6例（6.9%）（根据欣奇分类为III-IV型）确诊为弥漫性腹膜炎。
13例患者接受了急诊剖腹手术。在初次检查时，通过超声检查诊断出17例结肠旁区域脓肿（根据欣奇分类为Ib-II型）。在这组患者中，在超声和X线联合控制下对不同部位的憩室源性脓肿进行了26次经皮引流，采用自锁式#8Fr“猪尾”引流管。所有操作均实现了脓肿经皮引流的技术成功。13例患者进行了单次引流，在1年至5年的观察期内，憩室病未复发。4例患者在结肠旁区域复发性脓肿经皮引流后接受了计划性结肠切除术。未报告与引流管安装技术相关的并发症，引流患者组无死亡病例。
对疑似憩室病炎症并发症患者进行超声检查是该病初步诊断的必要且充分方法。憩室源性脓肿（欣奇Ib-II型）的经皮引流是复杂憩室病患者务实的“一线”选择，在大多数情况下可有效治疗该疾病。
