Application of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in severe intra-abdominal infection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DENG Zhenfeng ^1,2 , WEN Zhang ² , XU Banghao ² , WANG Jilong ² , WU Guolin ^1,2 , PENG Minhao ² ,  GUO Ya ²

1. Guangxi Medical University, Nanning 530021, P. R. China;
2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;

Corresponding author：

GUO Ya, Email: guoygxmu@163.com

Keywords：

severe intra-abdominal infection; sepsis; choledochoscope; debridement; catheter drainage

DOI：

10.7507/1007-9424.201907050

Video：

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Objective To investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).Methods The clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.Results Of the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.Conclusions Ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.

Citation： DENG Zhenfeng, WEN Zhang, XU Banghao, WANG Jilong, WU Guolin, PENG Minhao, GUO Ya. Application of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in severe intra-abdominal infection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(1): 43-47. doi: 10.7507/1007-9424.201907050 Copy

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5.	Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med, 2016, 193(3): 259-272.
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14.	尚丽明, 唐华民, 李仕来, 等. 应用不同类型引流装置治疗创伤后肠瘘的对比研究. 创伤外科杂志, 2017, 19(9): 654-656.
15.	保红平, 姚永良, 高瑞岗, 等. 腹腔双套管持续冲洗负压引流技术在腹部外科的临床应用. 中国普外基础与临床杂志, 2011, 18(12): 1323-1324.
16.	Boomer JS, Green JM, Hotchkiss RS. The changing immune system in sepsis: is individualized immuno-modulatory therapy the answer? Virulence, 2014, 5(1): 45-56.
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18.	Delano MJ, Ward PA. The immune system’s role in sepsis progression, resolution, and long-term outcome. Immunol Rev, 2016, 274(1): 330-353.
19.	Ou L, Chen J, Hillman K, et al. The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study. Crit Care, 2017, 21(1): 34.
20.	Bosmann M, Ward PA. The inflammatory response in sepsis. Trends Immunol, 2013, 34(3): 129-136.
21.	Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg, 2018, 13: 7.
22.	任建安. 腹腔开放疗法在腹部创伤的应用. 创伤外科杂志, 2015, 17(3): 193-196.
23.	Carlson GL, Patrick H, Amin AI, et al. Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg, 2013, 257(6): 1154-1159.
24.	张昕. CT 机定位下穿刺引流治疗严重腹腔感染合并腹腔脓肿疗效研究. 河北医学, 2015, 21(7): 1079-1081.
25.	Rivera-Sanfeliz G. Percutaneous abdominal abscess drainage: a historical perspective. AJR Am J Roentgenol, 2008, 191(3): 642-643.
26.	Levin DC, Eschelman D, Parker L, et al. Trends in use of percutaneous versus open surgical drainage of abdominal abscesses. J Am Coll Radiol, 2015, 12(12 Pt A): 1247-1250.

1. 任建安, 黎介寿. 严重腹腔感染的综合治疗. 中国实用外科杂志, 2007, 27(12): 940-942.
2. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
3. Jacob JA. New sepsis diagnostic guidelines shift focus to organ dysfunction. JAMA, 2016, 315(8): 739-740.
4. Perner A, Cecconi M, Cronhjort M, et al. Expert statement for the management of hypovolemia in sepsis. Intensive Care Med, 2018, 44(6): 791-798.
5. Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med, 2016, 193(3): 259-272.
6. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med, 2006, 34(2): 344-353.
7. 中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018). 临床急诊杂志, 2018, 18(9): 567-588.
8. Boldingh QJ, de Vries FE, Boermeester MA. Abdominal sepsis. Curr Opin Crit Care, 2017, 23(2): 159-166.
9. 徐麟, 石鑫, 李盖天, 等. 损伤控制理论在腹腔脓毒症中的应用进展. 中国普外基础与临床杂志, 2019, 26(2): 253-256.
10. 周波, 任建安. 腹腔开放疗法研究进展. 中国实用外科杂志, 2016, 36(2): 248-251.
11. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med, 2013, 39(7): 1190-1206.
12. Hirasawa H, Oda S, Nakamura M. Blood glucose control in patients with severe sepsis and septic shock. World J Gastroenterol, 2009, 15(33): 4132-4136.
13. Englert JA, Rogers AJ. Metabolism, metabolomics, and nutritional support of patients with sepsis. Clin Chest Med, 2016, 37(2): 321-331.
14. 尚丽明, 唐华民, 李仕来, 等. 应用不同类型引流装置治疗创伤后肠瘘的对比研究. 创伤外科杂志, 2017, 19(9): 654-656.
15. 保红平, 姚永良, 高瑞岗, 等. 腹腔双套管持续冲洗负压引流技术在腹部外科的临床应用. 中国普外基础与临床杂志, 2011, 18(12): 1323-1324.
16. Boomer JS, Green JM, Hotchkiss RS. The changing immune system in sepsis: is individualized immuno-modulatory therapy the answer? Virulence, 2014, 5(1): 45-56.
17. Delano MJ, Ward PA. Sepsis-induced immune dysfunction: can immune therapies reduce mortality? J Clin Invest, 2016, 126(1): 23-31.
18. Delano MJ, Ward PA. The immune system’s role in sepsis progression, resolution, and long-term outcome. Immunol Rev, 2016, 274(1): 330-353.
19. Ou L, Chen J, Hillman K, et al. The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study. Crit Care, 2017, 21(1): 34.
20. Bosmann M, Ward PA. The inflammatory response in sepsis. Trends Immunol, 2013, 34(3): 129-136.
21. Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg, 2018, 13: 7.
22. 任建安. 腹腔开放疗法在腹部创伤的应用. 创伤外科杂志, 2015, 17(3): 193-196.
23. Carlson GL, Patrick H, Amin AI, et al. Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg, 2013, 257(6): 1154-1159.
24. 张昕. CT 机定位下穿刺引流治疗严重腹腔感染合并腹腔脓肿疗效研究. 河北医学, 2015, 21(7): 1079-1081.
25. Rivera-Sanfeliz G. Percutaneous abdominal abscess drainage: a historical perspective. AJR Am J Roentgenol, 2008, 191(3): 642-643.
26. Levin DC, Eschelman D, Parker L, et al. Trends in use of percutaneous versus open surgical drainage of abdominal abscesses. J Am Coll Radiol, 2015, 12(12 Pt A): 1247-1250.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in severe intra-abdominal infection

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