肛门直肠周围脓肿的诊断与治疗

肛管、直肠周围间隙发生化脓性感染并形成脓肿称为肛门(管)直肠周围脓肿(简称肛周脓肿).肛周脓肿是临床常见病、多发病,尤以男性多见,根据982例病人统计,男女发病比例为7.2:1.传统的治疗方法是脓肿切开引流,但其中57.5%将形成肛瘘,需二次手术.近年来许多学者主张行根治性手术治疗,但仍有一些病人不能一次治愈.     

经直肠超声检查诊断肛门直肠周围脓肿

肛门直肠周围脓肿(肛周脓肿)是一种肛腺感染后炎症向肛管直肠周围间隙组织蔓延而发生的化脓性疾病。本文对12例临床疑为肛周脓肿患者经直肠超声检查，探讨经直肠超声检查对肛周脓肿诊断及指导治疗的意义。     

一次性根治术治疗肛门直肠周围脓肿86例临床观察

目的探讨肛门直肠周围（肛周）脓肿的有效治疗方法，以提高疗效。方法对我院2007年8月－2009年3月收治的86例肛周脓肿根据脓肿发生部位不同，分别采用一次性切开、低位切开高位黏膜挂线、脓肿切开对171引流、脓肿切开胶管引流、脓肿切开高位挂线等手术方法进行治疗。结果86例均一次手术治愈，术后随访3～6个月，均无复发，亦无肛瘘形成及其他后遗症。结论肛周脓肿可根据不同病情采取合理的手术方式，提高一次性治愈率。     

肛门直肠周围脓肿60例治疗体会

目的：总结直肠肛管周围脓肿（肛周脓肿）的治疗体会。方法：对行外科手术治疗的60例肛周脓肿患者的临床资料进行分析。结果与结论：60例中，采用单纯脓肿切开引流术48例，脓肿切开弓l流加挂线术12例。所有患者术程均顺利，出血量甚少，术后予流质饮食2～3d以控制排便，术后10-12h排尿，术后1～4d排便。56例获随访4—6个月，均彻底治愈，无漏管形成、肛门失禁、肛门狭窄或肛门出血等并发症，无再发肛周脓肿，余4例失访。肛周脓肿手术应注意寻找脓肿内口，正确处理感染内口，术中尽量避免损伤肛门括约肌，以减少术后肛门失禁、狭窄或出血发生率。术后保证引流通畅、充分，注意配合行局部治疗和全身抗感染、对症治疗等是避免发生术后感染的关键。     

解读肛周脓肿和肛瘘治疗指南

肛门直肠周围脓肿、肛瘘是常见的肛门部疾病，肛周脓肿是肛腺受细菌感染后在肛门周围软组织引起的化脓性疾患。这些脓肿通常发生在直肠周围的各个间隙，并最终在肛门附近的体表形成肛管或直肠下段与会阴部皮肤相通的肉芽肿性管道，称为肛瘘。美国结直肠外科医师协会（ASCRS）曾在1996年制订了《肛瘘治疗指南》。     

高频电刀肛周脓肿一期切开挂线46例

肝门直肠周围脓肿是肛内外的细菌感染向肛管周围间隙蔓延最终化脓而形成的脓肿。肛周脓肿成瘘率极高，高频电刀一期切开挂线术，治疗肛周脓肿，较传统的先行脓肿切开引流，三个月后成瘘二期挂线方法，缩短疗程，减轻患者痛苦，治愈率高。现将笔者应用高频电刀一期切开挂线治疗46例报告如下：     

藻酸盐填充条换药对肛周脓肿的疗效观察

肛周脓肿是肛肠科常见急诊，系肛周软组织的各类急慢陛化脓性感染，而肛周脓肿切开引流术是治疗该症的根本方法。2007年3月至2008年9月，本科共收治肛门直肠周围脓肿患者60例，分别采用藻酸盐填充条引流换药和凡士林油纱条引流换药，观察比较换药时间和换药效果。结果显示运用藻酸盐填充条引流换药是较理想的换药方法。现报告如下。     

结合会阴部MRI行扩创引流术治疗骨盆直肠间隙脓肿27例临床疗效观察

正肛周脓肿是肛管、直肠周围软组织内或其周围间隙内发生急性化脓性感染,按脓肿发生的部位可分为低位脓肿和高位脓肿。骨盆直肠间隙脓肿属于高位肛周脓肿,较少见,约占肛周脓肿2.5%。其位置较深,术后常易反复发作、易形成肛瘘,给患者带来较大痛苦。为探治疗方法疗效,本研究回顾分析2009年1月—2015年10月在本院收治骨盆直肠间隙脓肿患者54例,其中结合会阴部MRI经肛门括约肌间隙行扩大清创引流术,术     

鱼刺引发肛周脓肿1例

肛周脓肿是肛肠科的一种急重症，是指肛门直肠周围软组织内或其周围问隙内发生的急性或慢性化脓性感染，并形成脓肿。肛周脓肿的患者在临床上并不少见，但竟然因为误吞下鱼刺，最后鱼刺卡在肛门引起肛周脓肿的病例比较少见，现报告如下。     

肛周脓肿使用抗生素治疗的临床观察

肛门直肠周围脓肿(简称肛周脓肿)是外科常见病，由肛腺感染引发肛周软组织化脓所致。本文提供33例初诊使用抗生素治疗的观察统计资料，以供参考。     

经尿道软性输尿管镜肾囊肿内切开引流术的围手术期护理

目的：总结5例经尿道软性输尿管镜肾囊肿内切开引流术围手术期的护理经验。方法术前重视心理护理；做好双J管的护理及充分的术前准备，如肠道准备、皮肤准备等。术后严密监护、密切观察病情，并预防双J管滞留，做好出院宣教，加强随访，保障患者得以顺利康复。结果本组5例手术均成功，术后均无并发症发生，患者恢复良好，痊愈出院。结论良好的围手术期护理是保证患者手术成功的条件之一。     

Perianal abscesses due to ingested foreign bodies

Four cases of perianal abscesses due to foreign bodies (FBs) impacted in the anal canal are reported. The clinical presentation mimics common causes of acute anal pain. Digital rectal examination under local or general anaesthesia and/or proctoscopy can establish the diagnosis, but may miss the presence of an FB. Incision and drainage of the abscess along with removal of the FB results in immediate pain relief and long-term cure. Impacted FBs must not be overlooked as an unusual cause of perianal abscess.     

ABSCESS: Applied Bedside Sonography for Convenient Evaluation of Superficial Soft Tissue Infections

Objectives: Soft tissue infections are a common presenting complaint in the emergency department (ED). The authors sought to determine the utility of ED bedside ultrasonography (US) in detecting subcutaneous abscesses. Methods: Between August 2003 and November 2004, a prospective, convenience sample of adult patients with a chief complaint suggestive of cellulitis and/or abscess was enrolled. US was performed by attending physicians or residents who had attended a 30‐minute training session in soft tissue US. The treating physician recorded a yes/no assessment of whether he or she believed an abscess was present before and after the US examination. Incision and drainage (I + D) was the criterion standard when performed, while resolution on seven‐day follow‐up was the criterion standard when I + D was not performed. Results: Sixty‐four of 107 patients had I + D–proven abscess, 17 of 107 had negative I + D, and 26 of 107 improved with antibiotic therapy alone. The sensitivity of clinical examination for abscesses was 86% (95% confidence interval [CI] = 76% to 93%), and the specificity was 70% (95% CI = 55% to 82%). The positive predictive value was 81% (95% CI = 70% to 90%), and the negative predictive value was 77% (95% CI = 62% to 88%). The sensitivity of US for abscess was 98% (95% CI = 93% to 100%), and the specificity was 88% (95% CI = 76% to 96%). The positive predictive value was 93% (95% CI = 84% to 97%), and the negative predictive value was 97% (95% CI = 88% to 100%). Of 18 cases in which US disagreed with the clinical examination, US was correct in 17 (94% of cases with disagreement, χ²= 14.2, p = 0.0002). Conclusions: ED bedside US improves accuracy in detection of superficial abscesses.     

How to Manage Pain and Improve Outcomes of Labial Abscesses

Cutaneous abscesses can be painful, particularly in areas of increased sensitivity. Incision and drainage is considered as the primary treatment for abscesses. However, inconsistencies in injection technique can lead to unnecessary pain during the procedure, leading to the use of conscious sedation to perform the procedure successfully. This case report provides an exemplar of an effective local anesthesia injection technique for labial abscess incision and drainage on a young adult woman. Injecting local anesthesia not only superficially but just deep of the cutaneous abscess can reduce unnecessary pain during incision and drainage procedures and the need for conscious sedation.     

无针缝合器在感染切口应用中的护理研究

目的 探讨和对比无针缝合器与传统的二期针线缝合和蝶形胶布对感染切口的闭合疗效.方法 50例肝胆术后切口感染患者,待切口引流物明显减少、创面有健康肉芽生长时,应用立辰无针缝合器逐步闭合切口.另81例肝胆术后切口感染患者分别采用蝶形胶布拉拢或二期传统针线缝合,对比三组切口自换药开始至切口拆线的愈合时间.结果 无针缝合组的愈合时间(23士6.5)d明显短于蝶形胶布拉拢组(31士10.4)d和二期传统针线缝合组(34±14.1)d组(P＜0.05).蝶形胶布拉拢组感染切口愈合时间略短于二期传统针线缝合组,但两组差异无显著意义(P＞0.05).结论 采用无针缝合器治疗感染切口可在引流换药的同时,逐步闭合切口,促进其早期愈合.     

封闭式负压引流治疗腹部切口脂肪液化及护理

目的探讨封闭式负压引流治疗腹部手术切口脂肪液化的疗效及护理。方法采用武汉维斯第医用科技有限公司一次性使用负压封闭引流护创材料治疗腹部手术切口脂肪液化10例。结果10例患者切口均痊愈，出现新鲜肉芽组织时间为4～12d，平均7．5d。8例切口自然愈合，2例经二期缝合愈合。结论封闭引流负压吸引，可充分引流切口渗液，促进肉芽生长，疗效可靠。     

降低外阴癌术后切口感染的相关因素探讨及护理

目的 探讨降低外阴癌根治术切口感染率的手术切口方式和护理方法等相关因素,减轻患者痛苦,预防并发症.方法 选取2009年5月～2011年10月我科收治的行外阴癌根治术患者56例,其中,手术切口和术后卧位改进的27例设为实验组,另外29例为对照组,将两组进行比较.结果 实验组切口感染率较对照组显著降低,无并发症发生.结论 手术方法的改进结合护理卧位改进是降低切口感染率的重要手段,引流管护理、压迫止血、伤口管理、术后排尿排便护理等均为降低切口感染率行之有效的方法.加强围手术期护理,可促进外阴癌根治术患者术后康复,提高患者的生活质量.     

产后近期内阴道壁间断拆线法的临床观察

<正>近年来由于提倡优生,侧切指征明显放宽,有的基层医院产科初产妇会阴侧切缝合术达85%以上[1],有医院报道会阴切口感染率达2.34%[2],临     

注射器负压吸引处理术后切口脂肪液化的护理探讨

随着肥胖人群的增加和电刀的普及使用，切口脂肪液化的发生有增多的趋势。据报道，切口脂肪液化与体型肥胖和术中使用高频电刀有关。腹部切口脂肪液化是腹部手术后常见的并发症之一，它常常会增加切口感染的机会，延长住院时间，增加病人精神上的痛苦和经济上的负担。     

Abscess incision and drainage in the emergency department--Part I

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. Incision is generally performed using local anesthesia, with intraoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary. Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage. The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.