ObjectiveTo 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).MethodsThe 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.ResultsOf 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.ConclusionsUltrasound-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.
Objective To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and (19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.
Objective To investigate the factors influencing the need for surgical intervention after percutaneous catheter drainage (PCD) in patients with infected necrotizing pancreatitis (INP), and to construct and validate a nomogram-based predictive model. MethodsA total of 197 INP patients who underwent PCD at the Second Hospital of Lanzhou University between January 2021 and December 2023 were retrospectively enrolled. Patients were randomly divided into a training cohort (n=137) and a validation cohort (n=60) in a 7∶3 ratio. Univariate and multivariate logistic regression analyses were performed in the training cohort, and a nomogram was developed based on the multivariate results. Model discrimination was evaluated using receiver operating characteristic (ROC) curves, calibration was assessed using calibration plots, and clinical utility was examined using decision curve analysis (DCA) in both cohorts. ResultsMultivariate logistic regression revealed that C-reactive protein (CRP) [OR=1.028, 95%CI (1.005, 1.051), P=0.015], neutrophil-to-lymphocyte ratio (NLR) [OR=1.876, 95%CI (1.240, 2.839), P=0.003], computed tomography severity index (CTSI) [OR=6.701, 95%CI (2.827, 15.884), P<0.001], and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [OR=1.353, 95%CI (1.075, 1.703), P=0.010]were independent predictors of surgical intervention after unsuccessful PCD. A nomogram was constructed accordingly. The areas under the ROC curve (AUCs) of the predictive model were 0.95 [95%CI (0.92, 0.98)]in the training cohort and 0.94 [95%CI (0.88, 0.99)]in the validation cohort. Calibration curves and Hosmer-Lemeshow goodness-of-fit tests demonstrated good agreement between predicted and observed outcomes (training cohort P=0.633, validation cohort P=0.236). DCA showed that the nomogram provided the greatest net clinical benefit within threshold probabilities of 5%–97% in the training cohort and 10%–95% in the validation cohort. ConclusionsThe predictive model which including CRP, NLR, CTSI score and APACHE II score has significant predictive value of surgical intervention following PCD failure in INP patients. The proposed nomogram offers a reliable tool for early identification and clinical decision-making in this population.
ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed. ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05). ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.