Rafiq Suhail, Dar Musaib Ahmad, Nazir Imran, Shaffi Fahad, Shaheen Feroze, Kuchay Ishfaq Ayoub
Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir, India.
Department of Radiodiagnosis and Imaging, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Lung India. 2020 Jul-Aug;37(4):316-322. doi: 10.4103/lungindia.lungindia_385_19.
Image-guided drainage is an established technique with a multitude of applications. The indications, techniques, and management of image-guided catheter drainage, however, continue to evolve. Image-guided drainage alone is sometimes sufficient for the treatment of a collection, but it can also act as an adjunct or temporizing measure before definitive surgical treatment. Drainage of a symptomatic collection is performed to drain pus from the cavity, working in conjunction with antibiotics. Infected collections accumulate antibiotics to a limited extent, which generally precludes effective treatment with antibiotics alone unless the collection is very small (1-3 cm). There are many indications for image-guided drainage in the chest, including pleural disease, lung parenchymal, pericardial, and mediastinal collections. Pleural collections represent a common clinical problem, for which image-guided drainage is recommended to reduce complications encountered as a result of blind drainage.
To evaluate the efficacy and complications of ambulatory catheter drainage system for infective and loculated pleural collection.
The study was conducted in the department of radiodiagnosis and imaging, Sheri Kashmir Institute of Medical Sciences Srinagar 2016 to 2018. It was prospective in nature. All the patients were referred from in patient department as cases of clinically symptomatic pleural collections with image-based evidence of loculations or septations. All 30 patients referred for drainage were imaged using suitable imaging technique (USG or CT) to quantise and document presence of septations and loculations in pleural collections. Mean attenuation of pleural fluid, presence of internal echo's and associated pleural thickening (>2mm) was noted.
The overall success rate in our study was 77%, with recurrence in 10 % of patients and failure rate of 13 %. The outcome as per etiology was success rate of 100% in parapneumonic effusion, 70 % in TB, 50 % in malignancy and 100% in pleural collection after recent surgical intervention. The common procedure related complications noted in our study were hemothorax (3%), post procedural pain (23 %), pneumothorax (3%).
Image guided percutaneous drainage of loculated pleural space collections is an effective and safe procedure.
影像引导下引流是一种成熟的技术，有多种应用。然而，影像引导下导管引流的适应证、技术及管理仍在不断发展。单纯影像引导下引流有时足以治疗积液，但它也可作为确定性手术治疗前的辅助或临时措施。对有症状的积液进行引流，目的是从腔隙中引出脓液，并联合使用抗生素。感染性积液对抗生素的蓄积作用有限，除非积液非常小（1 - 3厘米），否则一般无法仅靠抗生素进行有效治疗。胸部影像引导下引流有很多适应证，包括胸膜疾病、肺实质、心包及纵隔积液。胸膜积液是一个常见的临床问题，推荐采用影像引导下引流以减少盲目引流导致的并发症。
评估门诊导管引流系统治疗感染性及分隔性胸膜积液的疗效及并发症。
本研究于2016年至2018年在斯利那加的谢里·克什米尔医学科学研究所放射诊断与影像科进行。研究为前瞻性。所有患者均由住院部转诊而来，临床症状为胸膜积液，并有基于影像的分隔或多房证据。所有30例转诊进行引流的患者均采用合适的影像技术（超声或CT）进行成像，以量化并记录胸膜积液中分隔和多房的情况。记录胸膜液的平均衰减、内部回声的存在情况及相关胸膜增厚（>2毫米）。
我们研究的总体成功率为77%，10%的患者复发，失败率为13%。根据病因，肺炎旁胸腔积液的成功率为100%，结核为70%，恶性肿瘤为50%，近期手术干预后的胸膜积液为100%。我们研究中常见的与操作相关的并发症为血胸（3%）、操作后疼痛（23%）、气胸（3%）。
影像引导下经皮引流分隔性胸膜腔积液是一种有效且安全的操作。
