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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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.	中國醫師協會急診醫師分會, 中國研究型醫院學會休克與膿毒癥專業委員會. 中國膿毒癥/膿毒性休克急診治療指南(2018). 臨床急診雜志, 2018, 18(9): 567-588.
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10.	周波, 任建安. 腹腔開放療法研究進展. 中國實用外科雜志, 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.
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14.	尚麗明, 唐華民, 李仕來, 等. 應用不同類型引流裝置治療創傷后腸瘺的對比研究. 創傷外科雜志, 2017, 19(9): 654-656.
15.	保紅平, 姚永良, 高瑞崗, 等. 腹腔雙套管持續沖洗負壓引流技術在腹部外科的臨床應用. 中國普外基礎與臨床雜志, 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. 腹腔開放療法在腹部創傷的應用. 創傷外科雜志, 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.	張昕. CT 機定位下穿刺引流治療嚴重腹腔感染合并腹腔膿腫療效研究. 河北醫學, 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, 黎介壽. 嚴重腹腔感染的綜合治療. 中國實用外科雜志, 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. 中國醫師協會急診醫師分會, 中國研究型醫院學會休克與膿毒癥專業委員會. 中國膿毒癥/膿毒性休克急診治療指南(2018). 臨床急診雜志, 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, 李蓋天, 等. 損傷控制理論在腹腔膿毒癥中的應用進展. 中國普外基礎與臨床雜志, 2019, 26(2): 253-256.
10. 周波, 任建安. 腹腔開放療法研究進展. 中國實用外科雜志, 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. 尚麗明, 唐華民, 李仕來, 等. 應用不同類型引流裝置治療創傷后腸瘺的對比研究. 創傷外科雜志, 2017, 19(9): 654-656.
15. 保紅平, 姚永良, 高瑞崗, 等. 腹腔雙套管持續沖洗負壓引流技術在腹部外科的臨床應用. 中國普外基礎與臨床雜志, 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. 腹腔開放療法在腹部創傷的應用. 創傷外科雜志, 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. 張昕. CT 機定位下穿刺引流治療嚴重腹腔感染合并腹腔膿腫療效研究. 河北醫學, 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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