Ren H J, Zhang J P, Tian R X, Wang G F, Gu G S, Hong Z W, Wu L, Zheng T, Zhang H Z, Ren J A
Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu 210002, China.
Department of General Surgery, Nanjing BenQ Hospital, Nanjing, Jiangsu 210000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Dec 25;23(12):1177-1181. doi: 10.3760/cma.j.cn.441530-20201103-00588.
To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) μg/L, 122.2 (55.8, 226.0) μg/L, 59.2 (29.0,203.5) μg/L and 64.1 (30.0,88.4) μg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (3.586, =0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all >0.05). Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.
探讨双套管经臀肌穿刺置管引流治疗深部盆腔脓肿的安全性及可行性。回顾性分析2017年5月至2020年9月在金陵医院行双套管经臀肌穿刺置管引流治疗深部盆腔脓肿患者的临床资料。纳入7例患者，其中男性5例，女性2例，年龄26 - 74岁（中位年龄53.0岁），均合并消化瘘。1例男性患者因引流管脱落再次穿刺，7例患者共行8次经臀肌穿刺置管引流，均在CT引导下进行。双套管组穿刺引流步骤如下：(1)侧卧位在CT下确定穿刺点；(2)将穿刺针置入脓肿腔内；(3)CT下确认穿刺针位于脓肿腔内；(4)拔出内芯，经操作孔插入双套管；(5)CT下确认双套管位于脓肿腔内；(6)妥善固定双套管，防止其脱落。收集所有患者引流前及引流后1天、3天、5天的白细胞、C反应蛋白（CRP）、降钙素原及白细胞介素-6（IL-6），以及引流液细菌培养结果。比较引流前后各项感染生物标志物的变化。7例患者均治愈。未观察到出血、剧痛等并发症。引流管留置时间平均为60.8（18 - 126）天。5例患者最终因胃肠瘘行胃肠重建手术。患者引流前、引流后1天、3天、5天血清白细胞介素-6的中位数分别为181.6（113.0，405.4）μg/L、122.2（55.8，226.0）μg/L、59.2（29.0，203.5）μg/L和64.1（30.0，88.4）μg/L。引流后3天和5天血清白细胞介素-6水平显著低于引流前（=3.586，=0.026）。虽然引流后白细胞计数、C反应蛋白及降钙素原较引流前逐渐下降，但差异无统计学意义（均>0.05）。双套管经臀肌穿刺置管引流操作简单、效果确切，可用于深部盆腔脓肿的治疗。
