Скачать или смотреть Percutaneous CT-guided drainage of a pelvic collection

Advances in abdominal surgical techniques such as laparoscopy and robotic surgery reduce hospitalization time and improve procedural outcomes. However, these techniques, have a not negligible risk of complications related to a long learning curve and a limited field of view during the procedure. Abdominal surgery frequently complicates with post-operative fluid collections that usually can be managed with a simple imaging monitoring until complete resolution is obtained. When persistent, collections have an increased risk of encountering superinfection with the onset of fever, abdominal pain, leukocytosis and, in some cases, the clinical evolution in septic shock.
The development of interventional radiology and of mini-invasive percutaneous techniques avoids re-intervention and controls post-operative pain and complications.

PROCEDURAL STEPS AND TECHNIQUE
Before the procedure a CT scan is performed: the collection is identified and the better percutaneous approach is selected. Contrast medium is usually performed to better define collection edges, vascular involvement and spatial relationships with the surrounding structures.
Once the percutaneous approach is selected, skin markers are placed on the patient for targeting the puncture site.
Local anesthesia is performed at the puncture site in order to control procedural pain; general anesthesia and deep sedation should be avoided when possible, in order to preserve patient collaboration (breath holding) during the procedure.
An initial puncture needle (22-18 Gauge) is placed under CT or fluoro-CT guidance into the collection and a minimal part of fluid is aspirated and sent for microbiological analysis. A guidewire (usually hydrophilic) is wrapped into the collection through the needle that is subsequently removed. Once the guidewire is stable in the collection, multiple passes with tissue dilator are performed to enlarge cutaneous breach. Finally, a 10-20 French drain tube is placed into the collection, according to fluid density.
Final CT scan is performed to check catheter position.

Gli avanzamenti delle tecniche chirurgiche come la laparoscopia e la chirurgia robotica hanno ridotto i tempi di degenza e migliorato anche gli outcome procedurali. Tuttavia queste tecniche, in quanto di recente introduzione, hanno un rischio di complicanze non trascurabile. La radiologia interventistica ha spesso il ruolo di controllo di queste complicanze, riducendo il tasso di re-intervento ed il passaggio ad una chirurgica "open".

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