Öz
AMAÇ :
İntra-abdominal apselere görüntüleme eşliğinde yaptığımız perkütan drenaj işlemlerinin etkinliğini, işlemlerin hangi kılavuz yöntemle yapıldığını, komplikasyonlarını, alınan örneklerden gelen kültür antibiyogram sonuçlarını ve hastalarımızın demografik özellikleri ile klinik sonuçlarını değerlendirmektir.
GEREÇ VE YÖNTEM :
Çalışmamız tek merkezli, retrospektif bir kohort çalışmasıdır.01/06/2017 - 01/06/2019 tarihleri arasında hastanemiz girişimsel radyoloji bölümünde perkütan drenaj tedavisi uygulanan hastaların elektronik tıbbi kayıtları incelendi.Hastaların yaşı, cinsiyeti, işlemin yapılma yöntemi, kılavuz için kullanılan modalite, kullanılan kateter, oluşan komplikasyonlar, kateterin kaç gün kaldığı, hastaların kültür antibiyogram sonuçları araştırıldı.
BULGULAR :
Perkütan drenaj ile kateter yerleştirirken 187 işlemde Seldinger tekniği, 6 işlemde Trokar yöntemi uygulandığı görüldü. Kateter mal pozisyonu, kateter tıkanması, apsenin tekrarlaması, drenajın yeterli olmaması gibi nedenlerle perkütan drenaj yapılan apselerden 89 (%50) tanesine ikinci bir işlem yapmak gerekti ve tekrarlayan kateter drenajı yapılan hastaların 75’i (%42) tedaviden sonra iyileşti. İntra-abdominal apselerde uygulanan perkütan drenaj tedavisinde toplamda başarı oranımız %92 olarak hesaplandı.
SONUÇ:
İntra-abdominal apselerde apse ile ilişkili intra-abdominal patoloji bulunmuyorsa perkütan drenaj işlemi tedavide ilk seçenek olarak değerlendirilmektedir. Perkütan drenaj işleminin erken dönem komplikasyonları yok denecek kadar az olup güvenli ve etkili bir tedavi yöntemidir. Hangi apselere sadece antibiyotik tedavisi verilmesi gerektiği, hangilerine ince iğneyle aspirasyonun yapılacağı, hangilerine drenaj kateteri yerleştirilmesi gerektiği, hangilerine açık cerrahi tedavi gerektiğine dair çalışmalar yapılmasına ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- Referans1. Akcam FZ, Ceylan T, Kaya O, Ceylan E, Tarhan OR. Etiology, treatment options and prognosis of abdominal abscesses: A tertiary hospital experience. J Infect Dev Ctries 2020;14(1):59-65. https://doi.org/10.3855/jidc.11277
- Referans2. Carbajo AY, Brunie Vegas FJ, García-Alonso FJ, et al. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses. Dig Endosc 2019;31(4):431‐438. https://doi.org/10.1111/den.13342
- Referans3. Cai YL, Xiong XZ, Lu J, et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: A systematic review and meta-analysis. HPB (Oxford) 2015;17:195-201. https://doi.org/10.1111/hpb.12332
- Referans4. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect 2010;11(1):79-109. https://doi.org/10.1086/649554
- Referans5. Politano AD, Hranjec T, Rosenberger LH, Sawyer RG, TacheLeon CA. Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: A review of 686 cases. The American Surgeon 2011;77(7):862-867.
- Referans6. Malik AA, Bari SU, Rouf KA, Wani KA: Pyogenic liver abscess: Changing patterns in approach. World J Gastrointest Surg 2010;2(12):395-401. https://doi.org/10.4240/wjgs.v2.i12.395
- Referans7. Akinci D, Akhan O, Ozmen MN, et al. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up. Cardiovasc Intervent Radiol 2005;28,744-750. https://doi.org/10.1007/s00270-004-0281-4
- Referans8. Damar Ç, Özdemir M, Hekimoğlu B. İntraabdominal apselerin görüntüleme eşliğinde perkütan drenajı. Dicle Med J 2019;46(1):73-83. https://doi.org/10.5798/dicletip.
- Referans9. Springer JE, Doumouras AG, Nair S, Eskicioglu C, Forbes S. Does imaging before percutaneous drain removal affect rates of intra-abdominal abscess recurrence? J Surg Res 2018;232:408-414. https://doi.org/10.1016/j.jss.2018.06.062
- Referans10. Cinquantini F, Piccinini A, Montanari N, Biscardi A, Tugnoli G, DiSaverio S. Percutaneous techniques for management of intra-abdominal abscesses. In: Di Saverio S, Catena F, Ansaloni L, Coccolini F, Velmahos G, ed. Acute Care Surgery Handbook. Springer, Cham, 2017;371-385. https://doi.org/10.1007/978-3-319-15341-4_21
- Referans11. Singh P, Tapasvi C, Kaur R, Aggarwal S, Nagpal N, Kaur R. Prospective randomized comparison of ultrasound‑guided percutaneous needle aspiration with percutaneous catheter drainage of liver abscesses. J Med Sci 2019;39:67-73. https://doi.org/10.4103/jmedsci.jmedsci_74_18
- Referans12. Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore) 2018;97(19):e628. https://doi.org/ 10.1097/MD.0000000000010628
Percutaneous drainage with a catheter in intra-abdominal abscesses under the guidance of imaging methods
Öz
Purpose: Evaluation of the effectiveness of percutaneous drainage methods for intraabdominal abscesses, guiding method of the procedures, the complications, the culture antibiogram results from the samples taken, and the clinical results of our patients.
Materials and methods: Our study is a single-center, retrospective cohort study. Electronic medical records of patients undergoing percutaneous drainage treatment in our hospital interventional radiology department between 01/06/2017-01/06/2019 were examined. The age and gender of the patients, the method of performing the procedure, the modality used for the guideline, the catheter used, the complications that occurred, the number of days the catheter was left, and the culture antibiogram results of the patients were investigated.
Results: It was observed that 187 of the catheter placement procedures with percutaneous drainage were applied Seldinger technique and 6 of them Trocar method. Due to reasons such as catheter malposition, catheter occlusion, recurrence of the abscess, insufficient drainage, 89 (50%) of the abscesses with percutaneous drainage were required to perform a second procedure, and 75 (42%) of the patients who underwent recurrent catheter drainage recovered after the treatment. Our overall success rate in percutaneous drainage treatment for intra-abdominal abscesses was calculated as 84.9%.
Conclusion: For intra-abdominal abscesses, if there is no intra-abdominal pathology associated with abscess, percutaneous drainage procedure is considered as the first choice in treatment. Early period complications of percutaneous drainage are almost none and it is a safe and effective treatment method. Studies need to be carried out on which abscesses should only be treated with antibiotics, which ones should be aspirated with a fine needle, which ones should be placed with a drainage catheter, and which ones require open surgical treatment.
Anahtar Kelimeler
Kaynakça
- Referans1. Akcam FZ, Ceylan T, Kaya O, Ceylan E, Tarhan OR. Etiology, treatment options and prognosis of abdominal abscesses: A tertiary hospital experience. J Infect Dev Ctries 2020;14(1):59-65. https://doi.org/10.3855/jidc.11277
- Referans2. Carbajo AY, Brunie Vegas FJ, García-Alonso FJ, et al. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses. Dig Endosc 2019;31(4):431‐438. https://doi.org/10.1111/den.13342
- Referans3. Cai YL, Xiong XZ, Lu J, et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: A systematic review and meta-analysis. HPB (Oxford) 2015;17:195-201. https://doi.org/10.1111/hpb.12332
- Referans4. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect 2010;11(1):79-109. https://doi.org/10.1086/649554
- Referans5. Politano AD, Hranjec T, Rosenberger LH, Sawyer RG, TacheLeon CA. Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: A review of 686 cases. The American Surgeon 2011;77(7):862-867.
- Referans6. Malik AA, Bari SU, Rouf KA, Wani KA: Pyogenic liver abscess: Changing patterns in approach. World J Gastrointest Surg 2010;2(12):395-401. https://doi.org/10.4240/wjgs.v2.i12.395
- Referans7. Akinci D, Akhan O, Ozmen MN, et al. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up. Cardiovasc Intervent Radiol 2005;28,744-750. https://doi.org/10.1007/s00270-004-0281-4
- Referans8. Damar Ç, Özdemir M, Hekimoğlu B. İntraabdominal apselerin görüntüleme eşliğinde perkütan drenajı. Dicle Med J 2019;46(1):73-83. https://doi.org/10.5798/dicletip.
- Referans9. Springer JE, Doumouras AG, Nair S, Eskicioglu C, Forbes S. Does imaging before percutaneous drain removal affect rates of intra-abdominal abscess recurrence? J Surg Res 2018;232:408-414. https://doi.org/10.1016/j.jss.2018.06.062
- Referans10. Cinquantini F, Piccinini A, Montanari N, Biscardi A, Tugnoli G, DiSaverio S. Percutaneous techniques for management of intra-abdominal abscesses. In: Di Saverio S, Catena F, Ansaloni L, Coccolini F, Velmahos G, ed. Acute Care Surgery Handbook. Springer, Cham, 2017;371-385. https://doi.org/10.1007/978-3-319-15341-4_21
- Referans11. Singh P, Tapasvi C, Kaur R, Aggarwal S, Nagpal N, Kaur R. Prospective randomized comparison of ultrasound‑guided percutaneous needle aspiration with percutaneous catheter drainage of liver abscesses. J Med Sci 2019;39:67-73. https://doi.org/10.4103/jmedsci.jmedsci_74_18
- Referans12. Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore) 2018;97(19):e628. https://doi.org/ 10.1097/MD.0000000000010628
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Radyoloji ve Organ Görüntüleme |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2021 |
| Gönderilme Tarihi | 12 Ekim 2020 |
| Kabul Tarihi | 23 Kasım 2020 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 14 Sayı: 3 |
Kaynak Göster
