Department of Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
Department of Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
J Vasc Interv Radiol. 2020 Apr;31(4):667-673. doi: 10.1016/j.jvir.2019.09.026. Epub 2020 Feb 26.
To determine predictors of outcomes for patients who undergo computed tomography (CT)-guided percutaneous abdominal or pelvic drainage catheter placement and to identify which patients benefit from fluoroscopic drainage catheter interrogation (abscessogram).
A retrospective review of 383 patients (mean, 52 years old; range 8-89 years old; 158 males: 225 females) who underwent 442 CT-guided procedures and 489 catheter placements for fluid collections in the abdomen or pelvis from January 1, 2015, to December 31, 2016 was performed. Variables including underlying disease, fluid location, number of collections drained, number of catheter exchanges and follow-up abscessograms performed, catheter size, and fistula detection were analyzed to determine factors associated with fistula formation and increased catheter dwell time.
A single abscessogram followed by catheter removal was performed for 217 catheters (44%). An increased number of abscessograms was significantly associated with drainage catheter size (P < .001) and presence of a fistula (P < .001). Fistulae were detected in 95 cases (19%) and were significantly associated with an increased number of drain exchanges (P < .001) and an underlying diagnosis of Crohn's disease (P = .02). Based on these data, a clinical algorithm for drain management is presented.
Abscessograms performed after CT-guided percutaneous drainage catheter placement are useful to detect catheter malposition, occluded catheters, and fistulae but are not necessary for all patients. If performed selectively, particularly in patients with an underlying diagnosis of Crohn's disease or those at high risk for developing fistulae, unnecessary examinations can be avoided, reducing cost, extra hospital visits, and radiation dose.
确定接受 CT 引导下经皮腹部或骨盆引流导管放置术的患者的结局预测因素，并确定哪些患者受益于透视引流导管检查（脓肿造影）。
回顾性分析了 2015 年 1 月 1 日至 2016 年 12 月 31 日期间，383 例（平均年龄 52 岁；年龄 8-89 岁；男性 158 例，女性 225 例）接受 442 次 CT 引导下腹部或骨盆积液引流术和 489 例导管放置术的患者。分析了包括基础疾病、积液位置、引流的积液量、导管更换次数、进行的随访脓肿造影次数、导管大小以及瘘管检测等变量，以确定与瘘管形成和导管留置时间延长相关的因素。
217 根引流导管（44%）仅进行了一次脓肿造影检查后即拔除导管。进行更多次脓肿造影检查与引流导管大小（P <.001）和瘘管存在（P <.001）显著相关。95 例（19%）患者发现瘘管，与更多次引流管更换（P <.001）和基础诊断为克罗恩病（P =.02）显著相关。基于这些数据，提出了一种引流管管理的临床算法。
CT 引导下经皮引流导管放置术后进行脓肿造影检查有助于发现导管位置不当、导管堵塞和瘘管，但并非所有患者都需要进行。如果选择性地进行，特别是对于基础诊断为克罗恩病或有发生瘘管风险的患者，可以避免不必要的检查，降低成本、额外的医院就诊次数和辐射剂量。
