Henrich H, Müller R D, Erhard J, Schlensak M, Langer R
Zentralinstitut für Röntgendiagnostik, Universitätsklinikum Essen.
Zentralbl Chir. 1998;123(3):251-6.
Today, CT-guided percutaneous drainage for intraabdominal abscesses of various origin and location is well accepted. With this method open surgery and its complications can be often avoided. We report results of such treatment in 47 patients with intraabdominal abscess formation. 66 "basket" catheters were placed into abscess formations of differing sizes and locations. 27 patients had developed abscess formation after surgery, in 2 patients abscesses after tumorembolisation were drained. In 18 cases there was no previous surgery. No complications occurred. Mean drainage time was 8.5 days. Surgical intervention was avoided in 34/47 patients. 9 of 47 patients received only percutaneous drainage. 25 of 47 patients required concomitant antibiotics for successful treatment. Antibiotics were selected according to bacterial culture with resistance determination. 13/47 cases required secondary surgery. About 80% of intraabdominal abscesses are curable with CT guided percutaneous drainage and systemic antibiotic medication. If a percutaneous drainage fails and signs of infection still remain, the procedure can be repeated. If secondary surgery after failing of percutaneous drainage should become necessary, the extent of the surgical intervention can be reduced. Surgery is necessary, if CT guided percutaneous drainage could not reach the abscess formation, if drainage failed or if an additional illness exists, which requires an operation.
如今，CT引导下经皮穿刺引流术对于各种病因和部位的腹腔内脓肿已被广泛接受。采用这种方法通常可以避免开腹手术及其并发症。我们报告了47例腹腔内脓肿形成患者的这种治疗结果。将66根“篮式”导管置入不同大小和部位的脓肿中。27例患者在手术后形成脓肿，2例患者在肿瘤栓塞后引流了脓肿。18例患者此前未接受过手术。未发生并发症。平均引流时间为8.5天。47例患者中有34例避免了手术干预。47例患者中有9例仅接受了经皮穿刺引流。47例患者中有25例需要联合使用抗生素才能成功治疗。根据细菌培养及耐药性检测结果选择抗生素。47例患者中有13例需要二次手术。约80%的腹腔内脓肿通过CT引导下经皮穿刺引流和全身抗生素治疗可治愈。如果经皮穿刺引流失败且感染迹象仍然存在，可以重复该操作。如果经皮穿刺引流失败后需要进行二次手术，手术干预的范围可以缩小。如果CT引导下经皮穿刺引流无法到达脓肿部位、引流失败或存在需要手术的其他疾病，则需要进行手术。
