超声引导穿刺扩张置管引流在高龄病人消化道穿孔治疗中的应用  

Application of ultrasound-guided puncture dilatation catheter drainage for complicated intraabdominal infection due to digestive tract perforation in elders

作　　者：刘鹏 陈尚传 李业云 张明金 Liu Peng;Chen Shangchuan;Li Yeyun;Zhang Mingjin(Department of General Surgery,No.901 Hospital,Joint Logistics Support Force of PLA,Anhui Hefei 230031,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇一医院普外科,安徽合肥230031

出　　处：《腹部外科》2025年第1期49-53,共5页Journal of Abdominal Surgery

摘　　要：目的 探讨超声引导下经皮穿刺扩张置管引流在治疗高龄病人消化道穿孔导致复杂腹腔感染(complicated intra-abdominal infection,cIAI)中的疗效。方法 回顾性分析2021年10月至2024年6月在中国人民解放军联勤保障部队第九〇一医院普外科治疗的31例高龄病人(≥80岁)消化道穿孔导致cIAI,经超声引导下穿刺后依次使用逐渐增粗管径的筋膜扩张器(F8~F30)扩张后置入双套管冲洗、负压引流治疗,观察引流前后病人的临床症状消失时间、体温、实验室炎性指标的变化情况。结果 31例病人在非手术治疗期间均行超声引导下经皮穿刺扩张置管引流治疗cIAI,病人住院时间为(31.12±9.13) d,拔管时间为(26.91±7.84) d。病人体温、白细胞计数自穿刺引流后第3天下降,与穿刺引流前比较,差异均有统计学意义(均P<0.05);白细胞介素-6、C反应蛋白、降钙素原穿刺引流后第1天明显下降,与穿刺引流前比较,差异均有统计学意义(均P<0.05)。18例(58.06%)病人单纯行超声引导穿刺扩张置管引流治疗后痊愈;6例(19.35%)病人置管后临床症状缓解,序贯行外科手术治疗后痊愈;5例(16.13%)病人因脓毒症导致多器官功能衰竭死亡;2例(6.45%)病人自动出院(1例为腹腔大出血,家属放弃治疗;1例因经济原因要求回当地医院继续治疗)。结论 超声引导穿刺扩张置管引流治疗高龄消化道穿孔导致的cIAI,可有效改善临床症状,快速降低炎症指标,具有易操作、小创伤、并发症少等优点,是存在相对手术禁忌病人的优选方案。Objective To explore the efficacy of ultrasound-guided percutaneous dilatation catheter drainage for complicated intra-abdominal infection(cIAI)due to digestive tract perforation(DTP)in elders.Methods From October 2021 to June 2024,retrospective review was performed for 31 elders aged≥80 year with cIAI due to DTP.After ultrasound-guided puncture,fascia dilator with gradually larger diameter(F8-F30)was successively utilized for expansion and followed by double-tube irrigation and negative pressure drainage.The changes of disappearance time of clinical symptom,body temperature and laboratory inflammatory parameters were recorded before and after drainage.Results Ultrasound-guided percutaneous dilatation and catheter drainage were performed.Average hospitalization stay was(31.12±9.13)day and average extubation time(26.91±7.84)day.Body temperature and leucocyte count dropped after the third day of puncture and the differences were statistically significant(P<0.05).Eighteen patients(58.06%)recovered after ultrasound-guided puncture dilatation catheter drainage alone.Clinical symptoms were relieved(n=6,19.35%)and cured after sequential surgery.Five patients(16.13%)died from multiple organ failure due to septicemia and 2 patients(6.45%)were automatically discharged.For one case of massive abdominal hemorrhage,family members gave up further treatment.Another case requested to return to a local hospital for further measures due to economic reasons.Conclusion Ultrasound-guided puncture dilatation and catheter drainage may effectively improve clinical symptoms and rapidly lower inflammatory parameters for cIAI due to DTP in elders.With the advantages of easy handling,economy,mini-invasiveness and few complications,it is ideal for patients with relative surgical contraindications.

关 键 词：高龄 消化道穿孔 复杂腹腔感染 超声引导穿刺 扩张置管引流 

分 类 号：R656.1[医药卫生—急诊医学]