Feld R, Eschelman D J, Sagerman J E, Segal S, Hovsepian D M, Sullivan K L
Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
AJR Am J Roentgenol. 1994 Nov;163(5):1141-5. doi: 10.2214/ajr.163.5.7976890.
The purpose of this study was to evaluate the clinical efficacy of transvaginal sonographically guided aspiration and drainage of pelvic fluid collections.
Forty patients underwent transvaginal sonographically guided aspiration of a possible pelvic abscess (41 pelvic collections). In patients with clinical findings highly suggestive of infection, both purulent and nonpurulent collections were immediately drained via a catheter. In patients with clinical findings moderately suggestive of infection, nonpurulent collections were completely removed by aspiration and the aspirates were cultured; however, purulent collections were immediately drained via a catheter.
All collections were successfully accessed by transvaginal sonography. For 27 of the 41 collections, the aspirate was purulent (18 collections) or the patient's clinical findings were highly suggestive of infection (nine collections) and catheter drainage was performed. Seventeen of the 27 collections completely resolved and surgery was not required. Four of the 27 collections were in patients who had surgery for reasons other than persistent infected collection. For six of the 27 collections, catheter treatment was not successful and surgery was required. The overall success rate of catheter drainage was 78%. In the remaining 14 of the 41 collections, the aspirate was serous or serosanguineous, and the patient's clinical findings were moderately suggestive of infection. Cultures of aspirates of seven collections were positive for microorganisms. Eleven collections were successfully treated with antibiotics or no therapy was required (based on culture results); for three, surgery was required. Two complications occurred: one vaginal fistula after catheter drainage and one disruption of vaginal sutures after aspiration.
Transvaginal sonographically guided drainage is effective treatment of pelvic abscess, being either completely curative or temporizing in 78% of patients. Catheter treatment was unsuccessful and surgery was necessary in 22% of patients. For nonpurulent collections, catheter drainage is indicated only when clinical findings are highly suggestive of infection.
本研究旨在评估经阴道超声引导下盆腔积液抽吸及引流的临床疗效。
40例患者接受经阴道超声引导下对可能存在的盆腔脓肿进行抽吸（共41处盆腔积液）。对于临床症状高度提示感染的患者，无论积液为脓性还是非脓性，均立即通过导管进行引流。对于临床症状中度提示感染的患者，非脓性积液通过抽吸完全清除，并对抽吸物进行培养；然而，脓性积液则立即通过导管进行引流。
所有积液均通过经阴道超声成功定位。41处积液中有27处，抽吸物为脓性（18处积液）或患者临床症状高度提示感染（9处积液），并进行了导管引流。27处积液中有17处完全消退，无需进行手术。27处积液中有4处患者因持续性感染积液以外的原因接受了手术。27处积液中有6处导管治疗未成功，需要进行手术。导管引流的总体成功率为78%。在41处积液中的其余14处，抽吸物为浆液性或血清样，患者临床症状中度提示感染。7处积液的抽吸物培养出微生物阳性。11处积液通过抗生素成功治疗或无需治疗（根据培养结果）；3处需要进行手术。发生了2例并发症：1例导管引流后出现阴道瘘，1例抽吸后出现阴道缝线断裂。
经阴道超声引导下引流是治疗盆腔脓肿的有效方法，在78%的患者中可完全治愈或起到暂时缓解作用。22%的患者导管治疗未成功，需要进行手术。对于非脓性积液，仅当临床症状高度提示感染时才进行导管引流。
