Author/Editor		Miletić, Damir; Uravić, Miljenko; Fučkar, Željko; Glavaš, Robert; Topljak-Polić, Dubravka
Title		Percutaneous drainage of abdominal fluid collections that require laparotomy or relaparotomy with ultrasound giudance
Translated title		Ultrazvočno vodena perkutana drenaža trebušne tekočine namesto laparotomije ali relaparotomije
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 35, št. 3
Publication year		2001
Volume		str. 167-73
Language		eng
Abstract		Background. The aim of the study was to determine efficacy and reliability of percutaneous abdominal drainage in surgical patients and to evaluate intercostal approach to drain subphrenic collections. Material and methods. Eighty-seven patients aged from 29 to 84 years (mean, 55.5 years) were percutaneously drained under the sonographic guidance due to the postoperative or nonoperated abdominal collection that would otherwise require laparotomy. Intercostal, subcostal, lateral and anterior approach with eight to 14 French catheters were used to evacuate abdominal collection. Results. The intercostal approach was used to drain 31 (60.8% of 51 subphrenic collections. The mean duration of drainage was independent of the intercostal or subcostal drainage route, but was significantly prolonged (p<0.05, Mann-Whitney U test) for purulent collections (median, 18 days; range 7-73 days) in comparison to hematomas, bilomas and other nonpurulent collections (median, 11 and 6 days, respectively). Sonographically guided percutaneous drainage was a definitive method in 92% patients, with 9.2% minor complications. Successful rate for subphrenic collections was even greater (96%). Conclusions. Sonographically guided percutaneous drainage is the method of choice in the treatment of abdominal collections that require laparotomy. If the puncture site is at least two intercostal spaces lower than the dome of diaphragm and catheter is not introduced through the pleural effusion, intercostal drainage is equally efficient and not less secure than subcostal approach.
Summary		Izhodišča. Namen študije je bil ugotoviti učinkovitost in zanesljivost perkutane trebušne drenaže pri kirurških bolnikih in ovrednotiti medreberno drenažo pri kopičenju tekočine pod trebušno prepono. Material in metode. 87 bolnikov, starih od 29 do 84 let (srednja starost 55,5 let) smo perkutano drenirali pod kontrolo ultrazvoka zaradi kopičenja tekočine v trebuhu po operaciji ali pri še neoperiranih bolnikih, kjer bi bila sicer potrebna laparotomija. Za odstranitev tekočine smo uporabljali katetre števila 8 do 14, ki smo jih uvedli med rebra ali pod njimi z lateralne ali sprednje strani trebuha. Rezultati. Z medrebernim pristopom smo drenirali 31 (60,8%) od 51 kopičenj tekočine pod trebušno prepono. Trajanje drenaže ni bilo odvisno od vrste pristopa, ali smo drenirali med rebri ali pod njimi. Značilno pa se je podalšalo trajanje drenaže (p<0.05, Mann-Whitney U test) pri gnojnih tekočinah (srednja vrednost 18 dni; razpon 7-73 dni) v primerjavi s hematomi, bilomi in drugimi negnojnimi kopičenji tekočine (srednja vrednost 11 in 6 dni). Ultrazvočno vodena perkutana drenaža je bila uspešna pri 92% bolnikov, manjših zapletov pa je bilo le 9,2%. Uspešnost posega je bila večja pri drenaži kopičene tekočine pod diafragmo (96%). Zaključki. Ultrazvočno vodena perkutana drenaža je metoda izbora pri odstranjevanju trebušne tekočine, kjer bi bila sicer potrebna laparotomija. Če je mesto vboda vsaj dva medreberna prostora nižje od oboka prepone in kateter ni uveden skozi pleuralno tekočino, je medreberna drenaža enako učinkovita in enako varna kot drenaža pod rebri.
Descriptors		ABDOMEN POSTOPERATIVE COMPLICATIONS ASCITIC FLUID DRAINAGE LAPAROTOMY SUBPHRENIC ABSCESS COLONIC NEOPLASMS