Image-guided drainage

图像引导式排水
  • 文章类型: Case Reports
    乙状结肠憩室炎可能导致盆腔脓肿的发展。腹内脓肿死亡率高达35%,合并脓肿的憩室炎患者发生复发性憩室炎的风险很高。最近,已使用计算机断层扫描或超声检查进行了图像引导引流,以治疗盆腔脓肿。标准的放射盆腔脓肿图像引导引流方法包括经腹,跨臀肌,或者颅尾穿刺方法。然而,由于骨盆内器官结构,这些标准方法具有技术局限性。因此,我们对2例72岁女性和53岁女性患者进行了图像引导引流术,患者采用更简单的一步穿刺法及侵入性较小的7-Fr引流导管,患者因标准入路困难而复发性盆腔脓肿并发乙状结肠憩室炎.在随访的计算机断层扫描中,两种情况下的脓肿都消失了,显示无盆腔脓肿复发。我们的结果表明,经膀胱图像引导引流是治疗盆腔脓肿的有效替代方法。
    Sigmoid diverticulitis can potentially lead to the development of pelvic abscesses. Mortality rate from intra-abdominal abscesses is as high as 35%, and patients with diverticulitis complicated by an abscess are at a high risk of recurrent diverticulitis. Recently, image-guided drainage has been performed using computed tomography or ultrasonography for the treatment of pelvic abscesses. Standard radiological pelvic abscess image-guided drainage methods consist of transabdominal, transgluteal, or cranio-caudal puncture approaches. However, these standard approaches have technical limitations due to intrapelvic organ structures. Therefore, we performed image-guided drainage using a percutaneous trans-bladder approach with a simpler 1-step puncture method and a less invasive 7-Fr drainage catheter in 2 cases of a 72-year-old female and a 53-year-old female with relapsed pelvic abscesses complicated by sigmoid diverticulitis due to difficulties involving the standard approach. The abscesses in both cases disappeared on follow-up computed tomography scans, demonstrating no pelvic abscess recurrence. Our results showed that trans-bladder image-guided drainage is an effective alternative method for treating pelvic abscesses.
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  • 文章类型: Journal Article
    胸腔脓胸是一种以脓液在肺的胸膜腔中积聚为特征的疾病。胸腔脓胸是男性高死亡率的原因,其发生率在儿童和成人中都在增加。传统上,胸管引流一直是首选的治疗方法,但是最近的研究表明,猪尾导管引流是一种更有效,侵入性较小的替代方法。图像引导引流也优于盲引流,正在探索替代的排水地点。这些管理改变改善了患者的预后并降低了并发症的风险。
    一名66岁的女性出现咳嗽,发烧,和胸痛。进行了临床检查,并进行了相关调查。然后,她接受了左侧胸脓胸的治疗。在超声引导下,通过后外侧入路,将猪尾导管通过左第9肋间间隙插入局部脓胸。
    本文的主要目的是概述一种罕见的脓胸管理方法,一种以肺部胸膜腔积脓为特征的病症。在这个案例报告中,作者将重点放在猪尾导管引流上,而不是传统的胸管引流上,和图像引导引流已经在盲目引流,确保准确的放置和减少损害周围组织的风险。脓胸管理的另一个显着变化是,根据超声引导下的定位部位,引流部位从安全三角形转移到其他部位。
    Empyema thoracis is a condition characterized by the accumulation of pus in the pleural cavity of the lungs. Empyema thoracis is a cause of high mortality in man and its occurrence is increasing in both children and adults. Traditionally, chest tube drainage has been a preferred method of treatment, but recent studies have shown that pigtail catheter drainage is a more effective and less invasive alternative. Image-guided drainage is also preferred over blind drainage, and alternative drainage sites are being explored. These management changes have improved patient outcomes and reduced the risk of complications.
    UNASSIGNED: A 66-year-old female presented with complaints of cough, fever, and chest pain. A clinical examination was done and relevant investigations were sent. She was then treated in the line of left-sided empyema thoracis. A pigtail catheter was inserted into the loculated empyema via the left 9th intercostal space through a posterolateral approach with ultrasonography guidance.
    UNASSIGNED: The main aim of this article is to provide an overview of a rare management approach for empyema, a condition characterized by the accumulation of pus in the pleural cavity of the lungs. In this case report, the authors have focused on pigtail catheter drainage over traditionally performed chest tube drainage, and image-guided drainage has been performed over blind drainage ensuring accurate placement and reducing the risk of damage to surrounding tissues. Another notable change in empyema management is the shift in drainage sites from the safety triangle to other sites based on the site of loculations under ultrasonography guidance.
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  • 文章类型: Journal Article
    目的:我们的目的是比较图像引导引流术加抗生素治疗(抗生素治疗)与单独的抗生素治疗输卵管卵巢脓肿(TOAs)的结果,并评估C反应蛋白(CRP)水平在预测抗生素治疗成功方面的作用。
    方法:这是194例TOA住院患者的回顾性研究。患者分为以下两组:除肠胃外接受抗生素治疗外还接受图像引导引流的患者,以及未接受图像引导引流并仅接受抗生素治疗的患者。入院当天(第0天)的CRP水平,住院第4天(第4天),并记录出院日(最后一天)。计算第4天和最后一天与第0天相比CRP水平降低的百分比。
    结果:共有106名患者(54.6%)接受了图像引导引流和抗生素治疗,而88例患者(45.4%)没有接受引流,只接受抗生素治疗。入院时,CRP平均水平为203.4(±96.7)mg/L,两组相似.与第0天相比,第4天的CRP水平平均下降了48.5%,在接受图像引导引流的组中统计学上更高。18例患者的抗生物治疗失败,与第0天相比,第4天治疗失败和CRP水平下降率之间存在统计学上的显着差异。根据接收机工作特性(ROC)分析,如果第4天测得的CRP水平与第0天相比下降<37.1%,则治疗失败的概率会增加(曲线下面积=0.755;95%置信区间,0.668-0.841;灵敏度,73.6%;特异性,60%)。
    结论:影像引导引流联合抗菌治疗TOA成功率高,较低的复发率,和较低的手术要求,第4天CRP水平的平均下降可以在治疗随访时监测。在单独接受抗生素治疗的患者中,如果第4天的CRP水平下降<37.1%,治疗方案应该改变.
    We aimed to compare the results of image-guided drainage in addition to antibiotic therapy (antibiotherapy) with antibiotherapy alone in the treatment of tubo-ovarian abscesses (TOAs) and evaluate C-reactive protein (CRP) levels in predicting the success of antibiotherapy.
    This was a retrospective study of 194 patients hospitalized with TOA. Patients were divided into the following two groups: those who underwent image-guided drainage in addition to parenteral antibiotherapy and those who did not undergo image-guided drainage and received antibiotherapy alone. CRP levels on the day of admission (day 0), day 4 of hospitalization (day 4), and day of discharge (last day) were recorded. The percentage of decrease in CRP levels during day 4 and the last day compared with that on day 0 was calculated.
    A total of 106 patients (54.6%) underwent image-guided drainage with antibiotherapy, whereas 88 patients (45.4%) did not undergo drainage and received antibiotherapy alone. At admission, the mean CRP level was 203.4 (± 96.7) mg/L and was similar in both groups. The mean decrease in the CRP level on day 4 compared with that on day 0 was 48.5% and was statistically higher in the group that underwent image-guided drainage. Antibiotherapy failed in 18 patients, and a statistically significant difference was observed between treatment failure and the rate of decrease in the CRP level on day 4 compared with that on day 0. According to the receiver operating characteristic (ROC) analysis, if the CRP level measured on day 4 decreased by < 37.1% compared with that on day 0, the probability of treatment failure would increase (area under the curve = 0.755; 95% confidence interval, 0.668-0.841; sensitivity, 73.6%; specificity, 60%).
    Image-guided drainage combined with antibiotherapy in the treatment of TOA has high success rates, lower recurrence rates, and lower surgical requirement, and the mean decrease in the CRP level on day 4 can be monitored at treatment follow-up. In patients receiving antibiotherapy alone, if the CRP level on day 4 decreases by < 37.1%, the treatment protocol should be changed.
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  • 文章类型: Multicenter Study
    目的:描述影像引导下的梗阻性Mullerian异常引起的有症状性血吸虫引流的病例,作为治疗急性疼痛症状和延迟需要复杂重建的梗阻性Mullerian异常的确定性治疗的临时措施。
    方法:获得了所有纳入机构的IRB豁免。回顾并描述了来自三家21岁以下的学术儿童医院的8名女性患者的回顾性病例系列,这些患者因通过图像引导的经皮经腹阴道或子宫引流术和介入放射学引流的阻塞性苗勒氏异常而有症状的血。
    结果:8例青春期梗阻性苗勒管畸形患者(6例阴道远端发育不全患者,一个子宫角阻塞的病人,据报道,一名患者患有高阻塞的半阴道)和有症状的血。所有远端阴道发育不全患者下阴道发育不全均大于3厘米,这通常需要复杂的阴道成形术和术后支架的使用。鉴于手术后不成熟和无法使用支架或扩张器或医疗复杂性,随后,他们接受了超声引导下的介入放射学(IR)引流,以缓解疼痛症状,其次是月经抑制。子宫角阻塞的患者有复杂的病史和手术史,需要围手术期计划,还进行了超声引导下的血肿引流,作为治疗急性症状的临时措施。
    结论:因梗阻性苗勒管异常而出现有症状性血吸虫的患者在心理上可能不够成熟,无法进行明确的复杂重建,需要在术后使用阴道支架或扩张器以防止狭窄和其他并发症。图像引导的有症状的血吸虫经皮引流可以缓解疼痛,直到患者准备接受手术治疗和/或留出时间进行复杂的手术计划。
    OBJECTIVE: To describe cases of image-guided drainage of symptomatic hematometrocolpos from obstructive Müllerian anomalies as a temporizing measure to manage acute pain symptoms and delay definitive management of the obstructive Müllerian anomalies that require complex reconstruction METHODS: Institutional Review Board exemption from all included institutions was obtained. A retrospective case series from 3 academic children\'s hospitals of 8 females under the age of 21 with symptomatic hematometrocolpos due to obstructive Müllerian anomalies drained by image-guided percutaneous transabdominal vaginal or uterine drainage with interventional radiology was reviewed and described.
    RESULTS: Eight pubertal patients with obstructive Müllerian anomalies (6 patients with distal vaginal agenesis, 1 patient with an obstructed uterine horn, and 1 patient with a high obstructed hemi-vagina) and symptomatic hematometrocolpos are reported. All patients with distal vaginal agenesis had greater than 3 cm lower vaginal agenesis, which would usually require complex vaginoplasty and use of postoperative stents. Given their immaturity and inability to use stents or dilators postoperatively or medical complexity, they subsequently underwent ultrasound-guided drainage of hematometrocolpos with interventional radiology to relieve pain symptoms, followed by menstrual suppression. The patients with obstructed uterine horns had complex medical and surgical histories requiring perioperative planning; they also underwent ultrasound-guided drainage of hematometra as a temporizing measure to manage acute symptoms.
    CONCLUSIONS: Patients presenting with symptomatic hematometrocolpos due to obstructive Müllerian anomalies might not be psychologically mature enough to undergo definitive complex reconstruction, which requires vaginal stent or dilator use postoperatively to prevent stenosis and other complications. Image-guided percutaneous drainage of symptomatic hematometrocolpos serves as a temporizing measure by offering pain relief until patients are ready to undergo surgical management and/or to allow time for complex surgical planning.
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  • 文章类型: Journal Article
    Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen.
    This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women\'s hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study.
    85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40 years, TOA diameter of larger than 7 cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44-3.94, p value < 0.001), compared to patients successfully managed conservatively.
    Patients who are above 40 years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA.
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  • 文章类型: Journal Article
    OBJECTIVE: Interventional radiology plays a central role in the management of complicated acute pancreatitis, contributing to image-guided drainages, treating haemorrhagic complications and maintaining the patency of the biliary tree. In addition, many of these patients require long-term venous access for antibiotics or parenteral feeding. The aim of this study was to evaluate the role and level of involvement of the interventional radiology in this sub-group of patients.
    METHODS: This was a single-centre retrospective review of all admissions for acute pancreatitis over a 5-year period. Each case was assessed to determine whether radiological intervention was utilised.
    RESULTS: Our review included 401 patients. A total of 18.7% (75/401) of patients required vascular access procedures and 18.4% (74/401) required image-guided drainage. A total of 1.2% (2/401) patients had embolisation procedures performed. The embolisation procedures were performed to treat a pseudoaneurysm that had formed. Overall, 20.9% (84/401) of patients were referred to the interventional radiology department for a procedure; a majority of these patients were referred for multiple procedures over the course of their admission. The patients in the \'severe pancreatitis\' category had a total of 154 procedures performed, which was 65.5% of the total procedures. On average, the patients who underwent multiple interventional procedures tended to have a longer admission and more complex disease.
    CONCLUSIONS: The diagnosis and treatment of complicated acute pancreatitis is heavily dependent on the interventional radiology department. A substantial proportion of patients with pancreatitis required radiological intervention as part of their management, the proportion of which increased significantly in complex disease.
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  • 文章类型: Journal Article
    OBJECTIVE: The purpose of this study was to retrospectively evaluate the safety and efficacy of posterior transperineal drainage in patients with presacral abscess.
    METHODS: The records of 21 patients (14 men, 7 women; mean age: 62.1±10 years) who underwent posterior transperineal drainage for the treatment of presacral abscess, either using fluoroscopy or computed tomography guidance, were retrospectively reviewed. Data were analysed with respect to technical success, tolerance, duration of drainage, complications and short-term outcome.
    RESULTS: A total of 28 posterior transperineal drainage procedures of presacral abscesses were performed in 21 patients, either using fluoroscopy (24/28; 86%) or computed tomography (4/28; 14%) guidance. Technical success rate was 89% (25/28 procedures) and clinical success rate 88% (22/25 technically successful procedures). Transperineal catheter drainage was maintained for 3-105 days (mean 31 days±26 [SD]). After three procedures (3/28; 11%) patients reported discomfort. No major complications were reported.
    CONCLUSIONS: This study suggests that posterior transperineal drainage is an effective, safe and well-tolerated procedure for the treatment of presacral abscess.
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