Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
Department of Radiology, Louisiana State University Health Shreveport, Shreveport, Louisiana.
Acad Radiol. 2020 Feb;27(2):e1-e9. doi: 10.1016/j.acra.2019.03.010. Epub 2019 Apr 26.
To assess the feasibility of paired catheter drainage for management of complex abdominal abscesses.
This was a single-center retrospective study of 54 patients (35 males; mean age 48.9 years) that underwent paired catheter insertion for complex abdominal fluid collections in an 18-month period. Complex collections were defined as abscesses ≥6 cm in diameter with septations, high viscosity fluid or necrotic debris, or abscesses with an associated fistula. Abscess etiologies included postoperative (n = 28), pancreatitis (n = 12), perforated bowel (n = 7), liver abscess (n = 4), and perihepatic from gallbladder perforation (n = 3). Paired catheter insertion was defined two catheters co-located within one collection through the same skin incision or two closely spaced insertion sites. Paired catheter insertion was used primarily as initial drainage for complex intraabdominal abscesses and for salvage drainage in collections that could not be evacuated by a single catheter. Primary paired catheter insertion was used in 45 patients and as salvage in nine patients.
Abscess resolution occurred in 51 (94.4%) patients. Patients had a median of three drainage procedures. Median duration of paired catheterization was 22 days. Seven abscesses recurred and all resolved with repeated drainage. Complications included one hemorrhage that was taken for surgical exploration. Overall, 48 patients had good clinical outcome, 3 patients died (multiorgan failure, n = 2; sepsis, n = 1), and 3 patients were lost to follow-up.
Percutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.
评估采用配对引流管治疗复杂腹腔脓肿的可行性。
这是一项单中心回顾性研究，共纳入 54 例（男性 35 例；平均年龄 48.9 岁）患者，他们在 18 个月内接受了配对引流管插入术以治疗复杂腹腔积液。复杂积液定义为直径≥6 cm 的脓肿，存在分隔、高粘度液体或坏死组织碎片，或伴有瘘管的脓肿。脓肿病因包括术后（n = 28）、胰腺炎（n = 12）、肠穿孔（n = 7）、肝脓肿（n = 4）和胆囊穿孔所致肝周脓肿（n = 3）。配对引流管插入是指通过同一皮肤切口将两根引流管置于同一脓肿内，或在两个紧密相邻的插入部位插入两根引流管。配对引流管插入主要作为复杂腹腔脓肿的初始引流和单根引流管无法引流的脓肿的挽救性引流。45 例患者采用初始配对引流管插入，9 例患者采用挽救性引流管插入。
51 例（94.4%）患者脓肿消退。患者中位引流次数为 3 次。中位引流管留置时间为 22 天。7 例脓肿复发，均经再次引流后消退。并发症包括 1 例出血，行手术探查。总体而言，48 例患者临床结局良好，3 例患者死亡（多器官功能衰竭，n = 2；脓毒症，n = 1），3 例患者失访。
经皮穿刺配对引流管是治疗复杂腹腔脓肿和单根引流管治疗无效的脓肿的可行方法。
