超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径>3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。     

Percutaneous abscess drainage

Literature published in the past year has focused on controversy over the indications for percutaneous abscess drainage, particularly drainage of hepatic, splenic, and renal abscesses. Percutaneous abscess drainage for intra-abdominal abscesses with enteric communication, perivascular abscesses, infected abdominal tumors, tuboovarian abscesses, and pancreatic collections is also reviewed.     

Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage.

Transvaginal ultrasonographically (US) guided procedures are simple and safe and often represent the only means of access to pelvic disease. Aspiration of cystic pelvic masses and core biopsy of solid pelvic masses can be easily performed by using the transvaginal route, an endoluminal US transducer, and a needle guide. Because of concerns about false-negative diagnosis and potential tumor seeding with biopsy of primary ovarian cystic lesions, the indications for transvaginal aspiration and biopsy of ovarian and adnexal lesions are predominantly therapeutic. Similarly, using an endoluminal probe with modification of the guide, one can also perform safe and effective trocar catheter drainage of pelvic abscesses via the transvaginal route. The transvaginal route is ideally suited to pelvic abscess drainage because of the proximity of the vaginal fornices to most pelvic fluid collections. The transvaginal route has the disadvantage of being semisterile; because of the risk of superinfecting previously noninfected pelvic pathologic conditions, the transvaginal approach should be used only for solid lesions or cystic lesions that can be completely aspirated. Familiarity with the transvaginal route of access is crucial for adequate treatment of many gynecologic and nongynecologic pelvic pathologic conditions.     

Percutaneous catheter drainage of amoebic liver abscess.

Fifteen patients with amoebic liver abscesses underwent percutaneous catheter drainage under ultrasonographic guidance. Thirteen patients had solitary abscesses (right lobe 12, left lobe 1), two had associated subdiaphragmatic collections, while two patients had multiple abscesses. The indications for the drainage included lack of response to medical therapy: imminent rupture in five cases; ruptured liver abscesses in three; enlarging abscesses after hospitalization in three; persistent symptoms in two; and large left lobe abscesses in two. The volume of the abscesses before drainage was 102-1008 ml (mean 432 ml). Pigtail catheters (8 F) were used in nine of the patients and 12 F sump catheters in six. When multiple abscesses and associated subdiaphragmatic collection were present, each was drained separately. The catheters were removed (mean 7 days, range 3-20 days) when patients became apyrexial, catheter drainage was less than 10 ml in 24 h and cavitogram showed a negligible cavity (mean residual volume 5.5 ml, range 3-15 ml). Complications included minor blood loss through the catheter for 12 h in one patient and reappearance of the abscess in another requiring further drainage. Our experience suggests that catheter drainage of amoebic liver abscesses in selected cases is safe and effective, and results in prompt and early resolution of the abscess cavity with restoration of normal parenchyma.     

Abscess drainage with CT and ultrasound guidance

The technique of catheter drainage of abscesses, while appearing to be a departure from standard surgical tenets, in reality adheres to accepted principles of abscess management. In properly selected candidates, most abscesses are adequately and safely drained by catheter. Catheter drainage has the advantages of avoidance of general anesthesia, less morbidity, and lower cost when compared with that of surgical drainage. Since catheter drainage does not preclude surgical drainage, in appropriate candidates percutaneous drainage should be considered initially for definitive therapy. Ultrasonography and CT have become the preferred methods of detecting abdominal abscesses and also of guiding percutaneous catheter drainage. Real-time sonography has the advantages of being inexpensive, "portable," and able to provide simultaneous imaging during catheter placement. CT provides greater accuracy in guiding drainage of small, deep abscesses, more accurate delineation of the extent and location of the collection, and better definition of the relationship of abscesses to bowel and blood vessels.     

Percutaneous drainage of postappendectomy abscesses complicated by enteric communication

Four patients with postappendectomy abscesses complicated by enteric fistulae were treated by percutaneous drainage. Sinograms, obtained at the time of the initial drainage, demonstrated communication to the cecum in 3 patients and to the small bowel in 1 patient. Complete cure was attained in 3 patients by percutaneous drainage. In the fourth patient, surgery was performed after 7 days of catheter drainage. Percutaneous drainage of abscesses with enteric communication requires a modified technique, which includes longer-term drainage than for simple noncommunicating abscesses.     

Percutaneous drainage of abscesses in patients with Crohn disease

Up to one-quarter of patients with Crohn disease present with abdominal abscesses at some point in their illnesses, most of which have enteric communication. The efficacy of percutaneous drainage alone vs either a combined percutaneous/surgical approach or a purely surgical approach has not been established. We reviewed the results of percutaneous drainage of nine abscesses in eight patients with Crohn disease. Six of these abscesses communicated with the intestine. Those with enteric communication had temporary palliation, with improved medical status. However, all patients required definitive surgery within 7 weeks of initial drainage. Percutaneous drainage in the three patients without enteric communication resulted in a permanent cure. Our experience with this small series suggests that abscesses that have an enteric communication in patients with Crohn disease can be temporarily palliated by percutaneous drainage. However, use of this technique is unlikely to result in long-term palliation or cure. It appears that abscesses with intestinal communication in Crohn patients can be cured by percutaneous therapy alone.     

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.     

Percutaneous drainage of abdominal abcess

The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.     

Percutaneous drainage of pyogenic liver abscesses

This report summarizes the results of percutaneous catheter drainage in 23 cases of primary or secondary pyogenic liver abscess. The overall success rate was 76%. Only three (60%) of five cases of secondary abscess (infected hematoma or infected tumor) were cured with catheter drainage, but 11 (91%) of the last 12 primary pyogenic abscesses were drained successfully. Six patients with abscesses of less than 4 cm in diameter required catheter drainage for less than 72 hr. Although six abscesses in the series appeared septated or multiloculated, only one required more than a single catheter for curative drainage. Diagnostic and technical considerations for successful drainage of hepatic abscesses are discussed. The differential diagnosis includes echinococcal disease and hepatic amebiasis. Therapeutically, specific measures should be taken to ensure proper catheter position to prevent contamination of the subphrenic, perihepatic, and pleural spaces. Percutaneous catheter drainage should be attempted as a first choice of treatment in all pyogenic hepatic abscesses.     

CT引导下经皮穿刺引流治疗阑尾周围脓肿

目的 评价CT引导下经皮穿刺引流阑尾周围脓肿的安全性和效果. 资料与方法 38例阑尾周围脓肿患者接受CT导向下经皮穿刺引流.回顾性分析患者的临床资料、置管数目、引流量、带管时间、并发症和随访结果. 结果 对5例脓肿＜4 cm者行细针单独抽吸,另33例各经皮置入一根引流管;引流脓液25～270 ml,平均80 ml;带管6～24天,平均9天;无严重并发症发生;随访31例,2例复发给予抗生素治愈. 结论 对液化完全且局限的阑尾周围脓肿,CT引导下经皮穿刺引流安全有效.     

Percutaneous abscess drainage in Crohn's disease

The effect of 18 percutaneous abscess drainage procedures on the clinical management of 10 patients with Crohn's disease was evaluated. Two abscesses occurred immediately after surgery (two patients), five were in the liver (three patients), and 11 were the result of direct spread of disease from adjacent transmural bowel involvement (seven patients). Both postoperative and all five hepatic abscesses were treated successfully with percutaneous drainage. In two of the seven patients with abscesses secondary to transmural bowel disease, percutaneous drainage resulted in resolution of the abscess without the need for any further surgical intervention. The remaining five patients had subsequent elective intestinal surgery in which a single-stage surgical resection and primary reanastomosis were performed successfully. Two of these patients had abscesses recur at the same location, prompting a repeat percutaneous drainage before surgery. No enterocutaneous fistulas secondary to percutaneous drainage developed in any of the 10 patients. These results indicate that percutaneous abscess drainage can be a valuable technique for treating abscesses that result as a complication of Crohn's disease.     

Percutaneous drainage of periappendiceal abscesses: review of 20 patients

Twenty patients with periappendiceal abscesses diagnosed by CT underwent percutaneous catheter drainage. Eighteen (90%) of the 20 patients were successfully treated by percutaneous drainage and antibiotic therapy alone. In two of these patients, however, small recurrent abscesses were diagnosed by CT 4 and 6 weeks after drainage, but these abscesses resolved with additional antibiotic therapy. Surgery was performed in two patients in whom percutaneous drainage failed. One was a diabetic patient who had a gas-forming abscess that extended into the posterior pararenal space. Surgery was necessary in a second patient because of a technical failure of catheter insertion, which resulted in perforation of the abscess cavity and peritonitis. Abscess sinograms in eight (44%) of 18 patients showed fistulas between the abscess cavity and the base of the cecum or appendix. However, the fistulas did not pose a problem in clinical management, and all closed within 14 days. Percutaneous drainage is an effective alternative to surgery in selected patients with periappendiceal abscesses.     

Ultrasound-guided puncture. Modern treatment of liver abscess

The treatment of liver abscesses has benefitted from progress in imaging, particularly ultrasonography which allows simple and reliable aspiration and drainage. A series of 32 cases is reported, consisting of 29 pyogenic abscesses and 3 amoebic abscesses. Eighty-one per cent of patients were cured by aspiration and/or drainage, while 19% of patients had to be operated. The mean hospital stay was 11 days. Failures of ultrasound-guided aspiration are essentially due to multifocal abscesses caused by multiple organisms.     

Renal and related retroperitoneal abscesses: percutaneous drainage

Renal and related retroperitoneal abscesses cause significant morbidity and mortality and almost always require drainage. The authors report 18 cases of percutaneous drainage of renal and related retroperitoneal abscesses, all of which were successfully managed. In 11 of these cases (61%), percutaneous drainage constituted the only treatment required. In the remaining seven (39%), the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy with fewer complications. These results are comparable to those achieved with percutaneous abdominal abscess drainage and justify the use of percutaneous drainage for renal and related retroperitoneal abscesses as the therapeutic procedure of choice.     

Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages

OBJECTIVE: We undertook this study to determine the incidence and results of repeated (secondary) percutaneous abscess drainage performed on recurrent abscesses after successful initial (primary) percutaneous abscess drainage. MATERIALS AND METHODS: Imaging studies from patients who underwent multiple drainages were reviewed to define a cohort of patients who underwent secondary percutaneous abscess drainage after successful initial percutaneous abscess drainage of the same abscess. Medical records of these patients were then reviewed to assess the results of secondary percutaneous abscess drainage. RESULTS: Forty-five abscesses in 43 patients required secondary percutaneous abscess drainage. Twenty-four of the 43 patients avoided surgery. Secondary percutaneous abscess drainage was successful in evacuating the abscess cavity in 39 (91%) of 43 patients. Duration of drainage and time until recurrence were not significant predictors for avoiding surgery. Mean duration of secondary percutaneous abscess drainage was significantly longer than mean duration of primary percutaneous abscess drainage, but duration of secondary percutaneous abscess drainage (25 vs 14 days, respectively; p = 0.007) did not differ significantly between patients who ultimately required surgery and those who did not (17 vs 11 days, respectively; p = 0.10). Time to recurrence ranged from 2 days to 1 year (mean, 51 days). CONCLUSION: After successful primary percutaneous abscess drainage, secondary percutaneous abscess drainage of recurrent abscesses succeeded in evacuating the abscess cavity in most patients, and surgery was avoided by slightly more than half. Patients with postoperative abscesses were significantly more likely to avoid surgery (p = 0.008), whereas patients with pancreatic abscesses were significantly more likely to require it (p = 0.03).     

Percutaneous drainage of chest abscesses in children

Seven patients ranging in age from 3 to 18 years underwent percutaneous drainage of eight intrathoracic abscesses. Five of the abscesses were mediastinal or paramediastinal and resulted from esophageal perforation or esophageal anastomotic leakage. The abscesses resolved in each case, with a mean catheter drainage time of 28 days and no need for surgical intervention. Three of the abscesses were intrapulmonary, and each lay adjacent to a pleural surface. All three lung abscesses resolved within 19-24 days, without thoracotomy or wedge resection.     

Efficacy of the intradecidual sign and fallacy of the double decidual sac sign in the diagnosis of early intrauterine pregnancy

PURPOSE: To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage or indwelling catheter placement. MATERIALS AND METHODS: The authors reviewed hospital records from 1995 to 1997 for patients undergoing US-guided aspiration of breast abscesses. Two radiologists reviewed the US, mammographic, and US-guided aspiration studies for the size, appearance, and drainage of abscesses. The medical records were reviewed for follow-up data. RESULTS: Thirteen patients aged 15-69 years underwent US-guided percutaneous aspiration of 13 breast abscesses. All patients presented with a palpable mass, nine of which were retroareolar. At US, four abscesses were oval, nine (including three with septa) were irregularly shaped, and five had a thick rind. Of seven abscesses 2.4 cm or smaller, two were almost completely drained and five were completely aspirated. All seven abscesses resolved without surgery. Of six women with incompletely aspirated abscesses larger than 2.4 cm (one 3 cm, four 4 cm, one 7 cm), five required surgical referral; one of these cases was referred after repeat aspiration had been performed. CONCLUSION: Percutaneous aspiration of breast abscesses can enable diagnosis of abscesses and be used to treat small abscesses if they are completely drained. Partial drainage of abscesses larger than 3 cm may be palliative, but incision and drainage still may be necessary for definitive treatment.     

Appendiceal abscess drainage

Appendicitis is the most common abdominal inflammatory process in children, and the most frequent indication for abdominal drainage encountered in pediatric interventional radiology. Imaging in the diagnosis of appendicitis is evolving with CT becoming more common, although the incidence of perforation is not definitely improving. Tailored CT techniques for the diagnosis of acute appendicitis are designed to expedite care, but are not optimal in the diagnosis or characterization of abscesses. In the appropriate clinical setting the CT study needs to be altered for appropriate therapeutic planning. Drainage of appendiceal abscesses utilizes multiple techniques, some of which are more useful in children than adults. Image-guided drainage can facilitate a more limited surgery and can avoid repeat surgery from postoperative abscesses. Radiation doses must be minimized due to the increased risk in children. This article will discuss imaging in children with suspected appendiceal abscesses and drainage techniques.     

Periappendiceal abscesses: percutaneous drainage

Percutaneous abscess drainage was performed in 21 patients who had periappendiceal abscesses. Fifteen patients had de novo abscesses, while six patients had persistent postsurgical abscesses. Nineteen of the 21 percutaneous drainages were successful. After percutaneous abscess drainage, interval appendectomy was simple and uneventful in all 14 patients in whom it was performed; four patients had appendices removed prior to percutaneous abscess drainage, and three elderly patients have not required appendectomy (follow-up 1 1/2-3 1/2 years). Percutaneous catheter drainage of periappendiceal abscess performed with computed tomographic guidance is effective and safe. Its benefits include imaging demonstration of the abscess; avoidance of an operation for abscess drainage; temporization of extremely ill patients; simplification of appendectomy, which is made elective; obviation of all operations in selected patients (e.g., elderly or with cardiopulmonary disease); and reduction of hospital stay and cost.