Ilie Mădălina, Opriţă Ruxandra, Șandru Vasile, Berceanu Daniel, Plotogea Oana, Constantinescu Alexandru, Diaconescu Diana, Negoi Ionuţ, Constantinescu Gabriel
Chirurgia (Bucur). 2018 Nov-Dec;113(6):799-808. doi: 10.21614/chirurgia.113.6.799.
Intraabdominal fluid collections can be a significant cause of morbi-mortality among patients with acute pancreatitis and those who underwent surgery, especially oncological ones. Nowadays, the treatment tends to be minimally invasive, so that the patient's recovery would be shorter and the quality of life higher. EUS (endoscopic ultrasound) has emerged in the last decade to fulfill that demand, alongside percutaneous and surgical drainage in the management of perigastric collections. Objectives: The main objective of this paper is to evaluate the efficacy of EUS guided drainage in terms of techincal and clinical success. Secondary objectives refer to the assessment of complete resolution of intraabdominal collection, presence of infection after drainage, overall survival. We conducted a prospective study by enrolling 31 patients who were diagnosed using EUS with perigastric intraabdominal fluid collections, from an overall of 788 EUS performed over a period of 2 years. We analyzed their evolution during 6 months after treatment, by regular examinations (ultrasound/endoscopic/computed tomography). All of them were in-patients of Bucharest Clinical Emergency Hospital, either in Endoscopy or in Surgery Departments. Data collected was processed in IBM SPSS Statistics 20. Overall mean age was 51 year and intraabdominal collections average was 109 mm (range 34 250 mm) and was correlated with the method of treatment (p 0.005). Patients underwent different methods for their intraabdominal collections: EUS drainage, CT (computed-tomography)- guided percutaneous drainage, surgical intervention, alone or combined when needed. Overall mortality was 9,3% and was mainly related to the severity of the case and sepsis. We conclude that endoscopic ultrasound can be the first choice for drainage of intraabdominal perigastric fluid collections because it is a safe and effective technique with 100 % technical success, and with over 80 % clinical success assures a better quality of life. For collections with a diameter larger than 127 mm, we can expect however the need of combined treatment, EUS and surgery.
腹腔内积液可能是急性胰腺炎患者以及接受手术（尤其是肿瘤手术）患者发病和死亡的重要原因。如今，治疗倾向于微创，以使患者恢复时间更短，生活质量更高。在过去十年中，内镜超声（EUS）应运而生，以满足这一需求，同时在胃周积液的管理中还有经皮引流和手术引流。目的：本文的主要目的是评估EUS引导下引流在技术和临床成功方面的疗效。次要目的包括评估腹腔内积液的完全消退情况、引流后感染的存在情况以及总体生存率。我们进行了一项前瞻性研究，纳入了31例经EUS诊断为胃周腹腔内积液的患者，这些患者来自两年内进行的总共788例EUS检查。我们通过定期检查（超声/内镜/计算机断层扫描）分析了他们在治疗后6个月内的病情演变。他们均为布加勒斯特临床急诊医院内镜科或外科的住院患者。收集的数据在IBM SPSS Statistics 20中进行处理。总体平均年龄为51岁，腹腔内积液平均为109毫米（范围为34至250毫米），且与治疗方法相关（p = 0.005）。患者针对其腹腔内积液接受了不同的治疗方法：EUS引流、CT（计算机断层扫描）引导下经皮引流、手术干预，必要时单独或联合使用。总体死亡率为9.3%，主要与病情严重程度和脓毒症有关。我们得出结论，内镜超声可作为腹腔胃周积液引流的首选方法，因为它是一种安全有效的技术，技术成功率达100%，临床成功率超过80%，可确保更好的生活质量。然而，对于直径大于127毫米的积液，我们预计需要联合治疗，即EUS和手术治疗。
