| 1 ObjectiveThis study reviewed the diagnosis and treatment of patients with periappendiceal abscess treated by ultrasound-guided percutaneous catheter drainage,with the objective to exploring the indications,effect,potentially delayed risk of undetected serious illness,complications of percutaneous catheterization and drainage(PCD),and necessity of interval appendectomy to prevent recurrence in the treatment of periappendiceal abscess.2 Material and methods2.1 PatientsThis research include a total of 37 patients with periappendiceal abscess treated by percutaneous catheterization and drainage from May 2016 to December 2017 in the department of ultrasonic diagnosis and treatment,Shandong Provincial Hospital.One patient with adrenal pheochromocytoma resection during the same hospitalization were excluded.So a total of 36 patients were included finally,and their medical records and image data stored in the ultrasonic workstation were obtained.2.2 Preoperative preparation2.2.1 Ultrasonic examinationTo observe the shape of the appendix,and whether there is fecal stone in the cavity and whether the appendix wall is continuous or not.To observe whether there is cystic mass around the appendix and its shape,scope,internal echo,and whether there is liquid dark area formed by free fluid in the abdominal cavity,etc.The outer diameter of the enlarged appendix was recorded and the size of the mass and the depth of the liquid dark area were measured.2.2.2 Laboratory examinationLaboratory indicators reflecting the inflammatory response of patients include routine blood test and C-reactive protein and prothrombin time which may be associated with haemorrhage were recorded.2.2.3 Contraindication checkThe patient who has obvious tendency of hemorrhage and coagulation dysfunction(prothrombin time>16s,PTA<40%,platelet count<50 x 109/L)and who taking anticoagulant drugs before operation or did not meet the preoperative preparation requirements or could not stop taking anticoagulant drugs should be contraindicated by PCD.2.3 Percutaneous catheterization and drainageAll patients were supine.The catheter was catheterizated by the Seldinger method(two-step method)after determining the puncture path.The pus samples were collected through a three-way tube for microbiological analysis.And then use a syringe to remove the pus through catheter.The ultrasound follow-up was carried out until vomica disappeared and the clinical symptoms obviously alleviated then pull out the catheter.2.4 Determinant criterion2.4.1 Criteria for determining the effectiveness of puncture therapy Clinical and laboratory inspection item of infection descending,or sonogram showing the purulent cavity disappearing or obviously shrinking and the range of hypoechoic edema in the surrounding intestine is reduced(the maximum diameter is reduced by more than 50%)which prove abscess regression.2.4.2 Criteria for determining the success of clinical treatment The abscess continuous drainage does not exceed 2 weeks and the symptoms of acute appendicitis such as right lower abdomen pain or fever did not sustained exceed 2 weeks during puncture treatment or recur within 2 weeks after puncture treatment.2.5 Statistical analysisAll statistical results were obtained using SPSS 14.0.Measurement data description adopts mean ± standard deviation(x ± s).Paired t-test were used to determine significant differences between the items obtained from before and after puncture.Differences showing values of P<0.05 were considered statistically significant.3 ResultAll patients underwent PCD within 1-3 days after hospitalized.A total of 40 catheters were inserted in 36 patients,with average 1.1 catheters per person.The temperature of the patients decreased 0.27 ± 0.2 ? on average at 24 hours after puncture,and the difference between body temperature of before and after puncture was statistically significant(t=2.199,P = 0.036).The catheters was removed after 5.1 ± 2.1 days drainage with purulent 35m1-385ml discharged by catheters.All patients(36/36,100%)have PCD are effective.The success rate of clinical treatment is 94.4%.In the study,2 patients(2/36,5.5%)with recurrent periappendiceal abscess were treated with puncture again,and 6 patients with recurrent acute appendicitis,among which there are 4 patients(4/36,11.1%)underwent appendectomy after 1 month to 15 months and 2 patients(2/36,5.6%)treated only by medicine.The rest 28 cases(28/36,77.8%)did not recur,of which one(1/36,2.78%)underwent interval appendectomy without recurrence 4 months after discharge.The proportion of appendectomy owing to recurrent acute appendicitis is 11.1%.4 ConclusionThe treatment of periappendiceal abscess by ultrasound-guided PCD has high success rate and fewer complications,which could be a safe and effective treatment for primary periappendiceal abscess.Patients without recurrent symptoms after successful treatment do not need interval appendectomy. |
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