Percutaneous Catheter Drainage In Treatment Research Articles

The Effect of Contrast-enhanced Ultrasound via Vessels and Surgical Drains Guidance Percutaneous Catheter Drainage in the Treatment of Pyogenic Liver Abscess.

Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess. Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA). A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups. The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05). Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.

Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study

Background Percutaneous catheter drainage (PCD) has been viewed as first-line treatment for pyogenic liver abscess (PLA), yet detailed guidance is lacking for best practice of PCD. This study investigated characteristics of patients with PLA who had received PCD, identified factors associated with prolonged fever, and aimed to evaluate the relationship between timing of PCD and clinical improvement. Methods This was a retrospective study of patients with PLA who had undergone PCD over a 7-year period. PCD performed when the liquefaction degree of abscesses was less than 30% and/or within 1 week after fever onset was defined as early PCD. Patients were grouped and analysed based on the timing of PCD (early vs. delayed). Factors associated with prolonged fever were also analysed using univariate and multivariate logistic regression. Results Among 231 patients with PLA, 81 treated with PCD were included in the study after exclusion. The size of abscesses ranged from 3.4 to 16 cm in diameter. Interestingly, the abscesses were predominantly multiloculated in this cohort (82.7%). The most common pathogen isolated from pus was Klebsiella pneumoniae (60.5%), followed by Escherichia coli (8.6%). The duration of fever was significantly shortened with early PCD as compared to delayed PCD intervention (p = .042). No statistical differences were found between the two groups with regard to catheter adjustment and salvage drainage. Maximum body temperature and diameter of abscess > 7.5 cm were found to be associated with prolonged fever while early PCD was inversely related to prolonged fever. Multivariate analysis suggested that early PCD treatment was an independent protective factor of prolonged fever (p = .030). Conclusions Large abscesses with loculation could be successfully treated with PCD, and early PCD protected patients with PLA from prolonged fever. Our findings suggest that early intervention should be provided if PCD is indicated in clinical practice. KEY MESSAGES Large abscesses and multiloculated abscesses can be treated with percutaneous catheter drainage. Early percutaneous catheter drainage is identified as a protective factor of prolonged fever among patients with pyogenic liver abscesses. Early intervention should be provided if percutaneous catheter drainage is indicated for pyogenic liver abscesses.

The effect of technical details of percutaneous catheter drainage on the clinical outcomes of infected necrotizing pancreatitis patients

Background/aim This study aimed to investigate the effect of technical details of percutaneous catheter drainage (PCD) on the clinical outcomes of patients with infected necrotizing pancreatitis (INP).Materials and methods A total of 44 INP patients treated in our hospital from October 2013 to October 2015 were included. The correlations of the first PCD treatment data and the clinical outcomes were analyzed.Results The number of catheters was positively correlated with hospital readmission (r = 0.335, P = 0.032). Receiver operating characteristic curve analysis showed that patients with ≥ 3 catheters were more likely to have hospital readmission. Patients with pleural effusion undergoing thoracentesis were more likely to have new intensive care unit admission (P = 0.025) and bleeding in need of intervention (P = 0.032). Patients with more effusion regions had higher incidences of mortality (P = 0.012) and new intensive care unit admissions (2.44 ± 1.03 vs. 1.88 ± 0.80; P = 0.059). Patients with PCD only were less likely to have new intensive care unit admissions (22.22% vs. 54.55%; P = 0.038) than those with PCD + small incision or/and videoscopic assisted retroperitoneal debridement. Conclusion Number of catheters greater than three was associated with unfavorable outcomes of PCD treatment in INP patients. Patients that received PCD treatment only had better outcomes.

Analysis of the Treatment Efficacy of Percutaneous Catheter Drainage Under CT Guidance for Severe Acute Necrotizing Pancreatitis

Background: Percutaneous catheter drainage (PCD) therapy is an important treatment for severe acute pancreatitis. Objectives: The purpose of this retrospective study was to analyze the relevant risk factors of computed tomography (CT) guided PCD during the treatment of infected pancreatic necrosis (IPN) in severe acute pancreatitis. Patients and Methods: This is a retrospective study. From January 2013 to November 2016, 162 patients suffering from severe acute pancreatitis with IPN were assessed using CT-guided PCD. Abdominal CT scan was performed for the patients. The interventional therapist chose the location and puncture according to the image. Depending on the efficacy and process of the treatment, these patients were divided into a PCD success treatment group and a PCD combined with surgery group. Factors affecting the success of PCD treatment were analyzed by logistic regression analysis. Results: Among the 162 cases, 71 cases (43.82%) were in the PCD success group and 91 cases (56.17%) were in the PCD combined with surgery group. Through the course of treatment, CT values of piercing zone, acute physiology and chronic health evaluation II (APACHEII) scores and modified CT severity index (MCTSI) scores showed statistically significant correlation with the therapeutic effect of PCD under CT guidance. A further multivariate analysis found that the CT value of puncture area is the best predictor for efficacy and when the CT value got higher the PCD efficacy would become lower. We performed further analysis of the factors associated with the average CT value in the puncture area which was higher than 20 Hounsfield unit (HU), and found that the length of time from patient admission to drainage, APACHEII scores, MCTSI scores and C reactive protein (CRP) levels were risk factors for PCD treatment efficacy. Conclusion: CT values of piercing zone is the major risk factor affecting the curative effect of CT guidance PCD. For patients with higher CT values in the puncture area, the longer time from patient admission to drainage, the higher APACHEII scores and MCTSI scores. Higher levels of C reactive protein seem to lower the curative effect.

Ultrasonic/CT image fusion guidance facilitating percutaneous catheter drainage in treatment of acute pancreatitis complicated with infected walled-off necrosis

BackgroundAs the firs-line treatment for acute pancreatitis (AP) related infectious walled-off necrosis (WON), percutaneous catheter drainage (PCD) are usually accomplished under CT or US guidance, either of which has certain disadvantages. It is necessary to verify the clinical effects of using US and CT images fusion as guidance of PCD. MethodsThe total 94 consecutive AP patients with infected WON from January of 2013 to January of 2017 were included. Among these patients with infected WON, 48 received PCD under simple US guidance (US-PCD) and 46 under US/CT images fusion guidance (US/CT-PCD). The clinical data consisting of puncture data, drainage effectiveness indicators, intervention complications were collected. ResultsThe demographic characteristics and disease related characteristics of two groups were comparable. After 48 h of PCD treatment, the US/CT-PCD group achieved a significantly higher imaging effective rate, and significantly lower inflammatory response indexes and severity score, than the US-PCD group (P < 0.05). The US/CT-PCD group required fewer puncture times and drainage tubes and lower rate of advanced treatment, showing higher operational success rate than the US-PCD group (P < 0.05). Moreover, the US/CT-PCD group exhibited significantly fewer puncture related complications, lower hospital stay, intubation time, and hospitalization expenses than the US-PCD group (P < 0.05). ConclusionPCD treatment under the US/CT images fusion guidance is a reliable intervention with definite clinical effects for AP complicated with infected WON.

Opposite effects of younger and older ages on severity and mortality in Acute Pancreatitis. A meta-analysis based on 191 678 patients

As the firs-line treatment for acute pancreatitis (AP) related infectious walled-off necrosis (WON), percutaneous catheter drainage (PCD) are usually accomplished under CT or US guidance, either of which has certain disadvantages. It is necessary to verify the clinical effects of using US and CT images fusion as guidance of PCD.The total 94 consecutive AP patients with infected WON from January of 2013 to January of 2017 were included. Among these patients with infected WON, 48 received PCD under simple US guidance (US-PCD) and 46 under US/CT images fusion guidance (US/CT-PCD). The clinical data consisting of puncture data, drainage effectiveness indicators, intervention complications were collected.The demographic characteristics and disease related characteristics of two groups were comparable. After 48 h of PCD treatment, the US/CT-PCD group achieved a significantly higher imaging effective rate, and significantly lower inflammatory response indexes and severity score, than the US-PCD group (P < 0.05). The US/CT-PCD group required fewer puncture times and drainage tubes and lower rate of advanced treatment, showing higher operational success rate than the US-PCD group (P < 0.05). Moreover, the US/CT-PCD group exhibited significantly fewer puncture related complications, lower hospital stay, intubation time, and hospitalization expenses than the US-PCD group (P < 0.05).PCD treatment under the US/CT images fusion guidance is a reliable intervention with definite clinical effects for AP complicated with infected WON.

Mo1258 - A Meta-Analysis and Systematic Review: Effect of Endoscopic Drainage on Length of Hospital Stay Compared to Percutaneous Catheter Drainage in Treatment of Acute Infected Necrotizing Pancreatitis

Mo1258 - A Meta-Analysis and Systematic Review: Effect of Endoscopic Drainage on Length of Hospital Stay Compared to Percutaneous Catheter Drainage in Treatment of Acute Infected Necrotizing Pancreatitis

Efficacy and safety of CT-guided percutaneous catheter drainage in treatment of uniloculated deep neck abscesses

Twenty-three patients with uniloculated deep neck abscesses(UDNA), in whom the antibiotic therapy failed and CT-guided percutaneous catheter drainage (PCD) was performed from January 2005 to June 2015, were included in the study.Catheter placement was carried out using Trocar technique in all cases.Open surgical drainage was performed when PCD procedures failed.The abscess was completely drained and open surgical drainage was avoided in 19 cases (83%); the surgical drainage was performed because of multiple internal septation in 3 (13%) case, and 1 (4%) case died from uremia.In this series the technical success rate and clinical success rate of PCD were 96% (22/23) and 83%(19/23), respectively.All patients were followed-up by CT scan.No other complications and no mortality occurred during the procedure, while postoperative pneumatosis developed in 1 case.CT-guided PDC is a safe and highly effective low-cost procedure for the treatment of patients with UDNA who failed medical therapy, it may be considered as an alternative to open surgery. Key words: Abscess, deep neck; Diabetes mellitus; Drainage, CT-guided

Controlled peritoneal drainage improves survival in children with abdominal compartment syndrome.

BackgroundChildren with massive ascites can develop abdominal compartment syndrome (ACS), which has been identified as an independent risk factor for mortality.ObjectivesThe objective of this study was to assess the effectiveness of volume-controlled percutaneous catheter drainage (PCD) for treating children with massive ascites and ACS.MethodsA retrospective descriptive study was conducted; Comprising 12patients with ACS with massive ascites treated with volume-controlled PCD in a pediatric intensive care unitof a university hospital in southern China from April 2011 to June 2013.ResultsThe etiology of ascites in these children included abdominal tumor (8/12), capillary leak after liver or kidney transplantation (2/12) and urine leakage (2/12). Intra-abdominal hypertension was closely associated with multiple organ dysfunction and high mortality. Digestive and pulmonary functions were the most frequently affected by ACS, while the cerebrum was the least involved. Treatment with ultrasound-guided PCD significantly decreased intra-abdominal pressure, abdominal circumference, and indices of organ dysfunction. PCD treatment also significantly improved glomerular filtration rate and PaO2/FiO2. Complications of PCD included abdominal infection (1/12) and electrolyte imbalance (4/12). The mortality rate of patients treated with PCD was 25%, which was lower than previous reports.ConclusionsControlled peritoneal drainage is a minimally invasive and safe decompression method that is effective in patients with ACS, and should be considered in children with massive ascites.

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Background and aims: Intra-abdominal hypertension, identified as an independent risk factor for death, leads to Abdominal Compartment Syndrome (ACS), which might be involved in the dysfunction of gastrointestinal tracts, respiratory system, cardiovascular system, renal system, and cerebrum. Aims: To compare the survival rates of between volume-controlled percutaneous catheter drainage (PCD) and non-PCD in children with massive ascites resulted from ACS. Methods: We conducted a comparative series case-study in 18 children with ACS treated in a university hospital southern China from April 2011 to June 2013. Patients with ACS were identified by intravesical pressure over 10 mmHg with evidence of newly-onset of organ dysfunction or failure. Massive ascites were revealed by ultrasonography and drained by PCD after ultrasound localization. Results: Of these 18 enrolled children, 11were treated with PCD, and 7 were treated without PCD. The etiology of these children included abdominal tumor (56%), capillary leak of post-operation of liver or kidney transplantation (17%), cirrhosis (17%) and urinary ascites (11%). For ACS, gastrointestinal tracts and pulmonary were the most frequently affected organs, while the cerebrum was the least involved. High intra-abdominal pressure (IAP) was closely associated with high mortality. Treatment with PCD significantly decreased IAP, abdominal circumference, and the number of organ dysfunction. PCD treatment also significantly reduced the mortality from 100% to 18.2%. However, we also found that as the complications of PCD, abdominal infection (9%)and electrolyte imbalance(9%)occasionally occurred. Conclusions: Controlled peritoneal drainage, a minimally invasive and safe decompression, is effective in patients with ACS and should be considered in children with massive ascites.

Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses

Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported.We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients’ characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years (±18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intra-abdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection.

Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis

To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage (PCD) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments. Eighty-one patients with severe acute pancreatitis (SAP) were admitted and divided into three groups: forty-nine cases in the conservative therapy group; nineteen cases in the surgery group; and thirteen cases in the PCD therapy group. Forty-five patients with a CT severity index (CTSI) < or = 8.0 received conservative treatment. One patient with CTSI = 7.0 underwent surgery. Thirty-five patients with a CTSI > 8.0 were randomly selected for surgery or PCD treatment. After randomization, six patients (four patients in the surgery group and two patients in the PCD group) were dropped from the study. The total number of patients included in the surgery and PCD groups was sixteen and thirteen, respectively. Four patients (8.2%) in the conservative therapy group died, five patients (31.3%) in surgery group with a CTSI > 8.0 died, and all patients in the PCD group survived. The mortality rate was lower in the PCD group than in the surgery group (P = 0.048). The serum C-reactive protein (CRP) level recovered more quickly in patients in the PCD group compared to those in the surgery group (P < 0.001). Patients with SAP and a CTSI < or = 8.0 could be treated with conservative therapy, while patients with a CTSI > 8.0 should be treated with surgery or PCD therapy if the life-threatening complications of extensive fluid collection or necrosis are a factor. However, PCD therapy used in a timely manner for drainage may decrease mortality in patients with SAP, decrease inflammatory mediator release, and avoid incidence of severe sepsis or acute respiratory distress syndrome (ARDS) and emergency surgery.

Percutaneous catheter drainage in treatment of urinary extraversation

In the last two decades there has been a rapid growth in the percutaneous manipulation of the genitourinary tract. We would like to present 2 patients in whom CT-guided percutaneous drainage of urinary extravasation was employed successfully and review the pertinent literature.