Schäberle W, Eisele R
Abteilung für Visceral-, Thorax- und Gefässchirurgie, Klinik am Eichert, Göppingen.
Chirurg. 1997 Jul;68(7):744-8. doi: 10.1007/s001040050265.
Because of the rare incidence of splenic abscesses and bleeding, only a few cases are described in the literature on percutaneous drainage of splenic abscesses. We report on eight cases (three male, five female, average age 74.1 +/- 10.76 years) of percutaneous, sonographically controlled catheter drainage of large splenic abscesses.
Percutaneous, sonographically controlled drainage of splenic abscesses was feasible in all eight cases in the last 5 years (trocar technique, drain: 12-16 F, abscess contents 70-750 ml). In seven of eight cases, therapy with percutaneous, sonographically controlled drainage of the splenic abscess and rinsing of the abscess cavity over several days was successful. In two cases, however, a recurrent abscess had to be drained repeatedly with sonographic control, and this was successful. In one case a colitis-related fistula prevented successful drainage of an infected subcapsular splenic hematoma. The following splenectomy, however, proved the infected hematoma to be completely drained. In this study there were no complications like bleeding, injury of pleura or colon. The advantages of percutaneous drainage are: the spleen is not removed; conservative therapy is beneficial, particularly in multimorbid patients with a high surgical risk; there is no transmission of bacteria; the method is safe and effective.
由于脾脓肿和出血的发生率较低,关于脾脓肿经皮引流的文献中仅描述了少数病例。我们报告了8例(3例男性,5例女性,平均年龄74.1±10.76岁)经皮超声引导下对巨大脾脓肿进行导管引流的病例。
在过去5年中,8例患者均可行经皮超声引导下脾脓肿引流术(套管针技术,引流管:12 - 16F,脓肿内容物70 - 750ml)。8例中有7例经皮超声引导下脾脓肿引流及脓肿腔冲洗数天的治疗成功。然而,有2例复发性脓肿需在超声引导下反复引流,且均成功。1例因结肠炎相关瘘管导致感染性脾包膜下血肿引流失败。但随后的脾切除术证实感染性血肿已完全引流。本研究中未出现出血、胸膜或结肠损伤等并发症。经皮引流的优点包括:脾脏未被切除;保守治疗有益,尤其对于手术风险高的多病患者;无细菌传播;该方法安全有效。