Liu Juanhan, Gong Wenbin, Liu Peizhao, Li Yangguang, Zheng Tao, Hong Zhiwu, Ren Huajian, Gu Guosheng, Wang Gefei, Wu Xiuwen, Zhao Yun, Ren Jianan
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
School of Medicine, Southeast University, Nanjing, China.
Front Surg. 2022 Mar 3;9:816245. doi: 10.3389/fsurg.2022.816245. eCollection 2022.
Traditional percutaneous catheter drainage (PCD) and surgical intervention could not always achieve satisfactory results for patients with Crohn's disease (CD) who have complications with intra-abdominal abscess. We proposed a trocar puncture with sump drainage for the treatment of CD with intra-abdominal abscess and compared it with the conventional PCD and surgical intervention.
Crohn's disease patients with intra-abdominal abscess and admitted to our hospital from 2011 to 2020 were identified by reviewing the electronic medical records. We divided them into Trocar, PCD, and fecal diverting (FD) groups, according to the ways of treating an abscess. Outcomes, risk factors for abscess recurrence, and postoperative complications were compared among the three groups.
A total of 69 patients were included and they were divided into Trocar ( = 18), PCD ( = 29), and FD ( = 22) groups. Four patients in the PCD group were transferred to receive the FD surgery due to the failure of initial treatment. The incidence of abscess recurrence was significantly higher in the PCD (48%) and FD (50%) groups compared to the patients using the trocar puncture with the sump drain (Trocar group) (16.7%). There were 8 patients in Trocar, 22 in PCD, and 20 s in the FD group who received enterectomy. None of the patients in the Trocar had an ultimate stoma and the incidence of postoperative complications was statistically lower [0% (Trocar) vs. 31.8% (PCD) vs. 45% (FD), < 0.05]. The way of initial treating of the abscess was significantly correlated with the abscess recurrence and postoperative complications.
Trocar puncture with a sump drain had a lower incidence of abscess recurrence, abdominal adhesions, postdrainage, and postoperative complications compared to the conventional PCD or surgical intervention.
对于患有腹腔内脓肿并发症的克罗恩病（CD）患者，传统的经皮导管引流（PCD）和手术干预并不总能取得令人满意的效果。我们提出了一种带负压引流的套管针穿刺术来治疗伴有腹腔内脓肿的CD，并将其与传统的PCD和手术干预进行比较。
通过查阅电子病历，确定2011年至2020年期间我院收治的患有腹腔内脓肿的克罗恩病患者。根据脓肿治疗方式，将他们分为套管针组、PCD组和粪便转流（FD）组。比较三组的治疗结果、脓肿复发的危险因素和术后并发症。
共纳入69例患者，分为套管针组（n = 18）、PCD组（n = 29）和FD组（n = 22）。PCD组有4例患者因初始治疗失败而转接受FD手术。与使用带负压引流的套管针穿刺术的患者（套管针组）相比，PCD组（48%）和FD组（50%）的脓肿复发率明显更高。套管针组有8例、PCD组有22例、FD组有20例患者接受了肠切除术。套管针组患者均未形成永久性造口，术后并发症发生率在统计学上较低[0%（套管针组） vs. 31.8%（PCD组） vs. 45%（FD组），P < 0.05]。脓肿的初始治疗方式与脓肿复发和术后并发症显著相关。
与传统的PCD或手术干预相比，带负压引流的套管针穿刺术的脓肿复发率、腹部粘连、引流后及术后并发症的发生率较低。
