胆道镜在腹膜后脓肿引流治疗中的应用

目的探讨胆道镜在腹膜后脓肿引流治疗中应用的方法及效果。方法选取1 8例经手术或置管引流的效果欠佳的腹膜后脓肿患者,用胆道镜经引流管窦道反复进入脓腔进行清创及冲洗。结果1 8例患者均得到有效治疗,1 7例治愈顺利拔管,1例患者因胰瘘6个月后行内引流手术治愈。结论腹膜后脓肿引流术后应用胆道镜辅助治疗,简单、安全,有效。     

腹膜后脓肿的诊断和治疗

目的探讨腹膜后脓肿的病因,诊断和治疗。方法回顾性分析了1990-2004年诊断和治疗腹膜后脓肿33例的临床资料。结果急性坏死性胰腺炎后20例,胆囊切除胆总管探查术后4例,十二指肠损伤2例,阑尾穿孔3例,肾结石4例。超声检查确诊80%(20/25),CT检查确诊100%(22/22)。经腹部腹膜后脓肿切开置管引流25例,手术1~4次不等,后腰部切开引流8例。手术后并发应激性胃粘膜损伤致消化道出血7例,成人呼吸窘迫综合征(ARDS)5例,急性肾功能衰竭3例,死亡4例。治愈时间1~6个月,平均3.5个月。结论及时明确诊断,进行有效引流并加强营养支持是治疗成功的关键。     

腹膜后脓肿的诊断和治疗

目的探讨腹膜后脓肿的病因，诊断和治疗。方法回顾性分析了1990—2004年诊断和治疗腹膜后脓肿33例的临床资料。结果急性坏死性胰腺炎后20例，胆囊切除胆总管探查术后4例，十二指肠损伤2例，阑尾穿孔3例．肾结石4例。超声检查确诊80％（20／25），CT检查确诊100％（22／22）。经腹部腹膜后脓肿切开置管引流25例，手术1～4次不等．后腰部切开引流8例。手术后并发应激性胃粘膜损伤致消化道出血7例，成人呼吸窘迫综合征（ARDS）5例，急性肾功能衰竭3例，死亡4例。治愈时间1～6个月．平均3．5个月。结论及时明确诊断，进行有效引流并加慢营养支持是治疗成功的关键。     

脑脓肿的诊断和治疗(附20例报告)

目的探讨脑脓肿的诊断和治疗.方法1996年1月～2004年6月20例脑脓肿均行CT检查,8例行MR检查中2例行磁共振波谱检查,应用头孢曲松联合甲硝唑治疗1～9周,平均3.7周.CT或B超引导下3例行脓肿切除术,5例行脓肿穿刺引流术.结果1例因脓肿破入脑室死亡,16例治愈(无后遗症),3例好转(残留肢体偏瘫).8例手术患者无一例死亡.合并有糖尿病、结核、HIV抗体阳性及肾移植8例中4例治愈,无相关疾病12例治愈;脓肿与脑室关系密切9例中有5例治愈,脓肿表浅11例均治愈.5例多发脓肿均治愈,15例单发脓肿有11例治愈.结论脑脓肿早期诊断、早期抗感染治疗大部可治愈,MR是早期明确诊断的重要方法,立体定向手术是较好的手术方式.     

外伤性膀胱破裂诊治的临床分析

目的探讨外伤性膀胱破裂的诊断及治疗方法,提高外伤性膀胱破裂的临床诊治水平。方法对23例外伤性膀胱破裂患者的病因、类型、临床表现、诊断方法、治疗方法及效果进行回顾性总结和分析。结果 23例中腹膜外型膀胱破裂15例,腹膜内型膀胱破裂8例。非手术治疗5例,均为腹膜外型膀胱破裂。手术治疗18例,其中腹膜外型膀胱破裂10例,腹膜内型膀胱破裂8例。23例患者均均治愈出院,未发生盆(腹)腔脓肿等严重并发症及死亡病例。结论膀胱造影应作为诊断外伤性膀胱破裂的首选方法。腹膜内型膀胱破裂应尽早手术治疗,无严重合并伤的腹膜外型膀胱破裂可考虑行非手术治疗。早期诊断,积极、合理、正确治疗,对降低外伤性膀胱破裂患者并发症发生率和病死率至关重要。     

肾皮质脓肿的诊断与治疗—附13例报道

目的 提高肾皮质脓肿的诊断与治疗。方法 对1991年3月．2004年6月收治的13例肾皮质脓肿病例的诊断与治疗进行回顾性分析。结果 抗炎治愈1例，经皮肾脓肿穿刺1例因引流不畅改行脓肿切开引流后痊愈。9例行脓肿切开引流后痊愈。误诊2例，均行根治性肾切除术。结论 肾皮质脓肿的诊断需结合临床表现：实验室检查、影像学检查综合分析，脓肿切开引流是主要的治疗方法。     

肝门部胆管癌的根治性切除术:附38例报告

目的 探讨肝门部胆管癌的诊断及根治性切除方法。方法 回顾性分析38例肝门部胆癌的临床特点、根治性切除方法及治疗效果。结果 术前均诊断明确。根治性切除38例，手术死亡3例(7.9％)。术后并发胆漏5例(13．2％)，其中2例并膈下脓肿，均经引流或再次手术引流治愈；右胸腔积液4例(10．5％)，均经保守治疗治愈；切口裂开3例(7．9％)，经再次缝合治愈。术后生存的35例中，有34例(97．1％)获得随访，1，3年生存率分别为91．9％，35．2％，无5年生存者。结论肝门部胆管癌早期诊断困难，联合应用影像学检查可明确诊断。目前根治性切除率仍较低，术后易复发和转移，鲜有长期生存者。提示即使是根治性手术，其切除和清扫范围可能仍然不够，其治疗手段有待进一步改进。     

经侧腹路腹膜后切开引流术治疗重症急性胰腺炎的体会

目的:探讨经侧腹路腹膜后切开引流术治疗重症急性胰腺炎（SAP）合并腹腔感染的可行性。方法:笔者对4例SAP合并腹腔感染患者在超声定位下经侧腹壁切开进行腹膜后坏死组织及脓肿清除、引流术。结果:4例均治愈出院。合并结肠瘘1例，持续引流治愈;合并腹腔出血1例，消化道出血1例，均采用非手术治疗痊愈。结论:笔者体会经侧腹路腹膜后切开引流治疗SAP合并腹腔感染是一种操作简便、创伤小、确实有效的手术方法。     

闈炵粡鑵规墜鏈不鐤楃粨鑲犳啯瀹ょ値寮曡捣鐨勭粨鑲犵槝骞惰嚧鑵硅啘鍚庤創鑲垮舰鎴?渚嬪苟鏂囩尞澶嶄範

背景与目的:结肠憩室炎引起结肠瘘并致腹膜后脓肿形成临床少见,本文通过回顾性分析1例结肠瘘致腹膜后脓肿形成患者的诊治经过,探讨结肠瘘的诊断及微创治疗方法,以期提高该病诊治水平。方法:回顾性分析中南大学湘雅二医院诊治的1例慢性结肠瘘患者临床资料,对患者的一般情况、发生肠瘘的相关因素、诊断、治疗进行分析,并结合文献复习。结果:明确诊断后,采取控制血糖、血压、抗感染、营养支持等对症治疗、脓肿切开持续冲洗引流、改善泌尿系症状、肠镜辅助下金属夹堵瘘口等综合治疗后,随访3个月,患者大便、饮食均正常,左输尿管、肾周未见明显异常,腹膜后脓肿愈合良好。结论:早期发现、诊断结肠瘘,给予保守、微创治疗,一种有效且安全可靠的方法,治疗时间短、恢复快,可使患者免受多次手术治疗的痛苦,适合于肠瘘合并内科疾病的中老年患者。     

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目的 总结23例腹膜后脓肿诊断和治疗的经验,认识其易致多器官功能障碍综合征（MODS）的重要性。方法 对1993－1999年诊治的23例腹膜后脓肿的临床资料进行回顾性总结。结果 经腹部腹膜后脓肿引流20例,手术1－6次不等,B超引导下经后腰部穿刺置管引流3例。术后合并应激性胃粘膜损害发生消化道出血6例,成人呼吸窘迫综合征（ARDS）5例,急性肾衰2例,腹腔内出血1例,小肠瘘3例,空肠结肠瘘1例,霉菌感染3例。全组平均住院72天。死亡4例,其中因ARDS、ARDS并应激性胃粘膜损害大出血、ARDS并腹腔内血管破裂出血分别死亡1例,应激性胃粘膜大出血并空肠结肠瘘死亡,结论 作为术后并发症,腹膜后脓肿常易致MODS,对其及时诊断,充分有效的引流是预防MODS的关键。     

Psoasabszesse

BACKGROUND: A psoas abscess is a rarely encountered entity with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, increased morbidity, and prolonged or recurrent hospitalization. PATIENTS AND METHODS: Between January 1996 and January 2002 we treated ten patients (approximately 54.8, 5 males,5 females). These cases were analyzed retrospectively relative to a review of the literature. RESULTS: CT scanning was decisive in the final diagnosis of psoas abscess. Primary psoas abscess occurred in four cases and six patients had secondary abscesses. In all except one case, the psoas abscess was located on the right side. The causes of primary abscesses were retroperitoneal perforated appendicitis, paravertebral injections for lumboischialgia, Pott's disease, and repeated intravenous drug application in the groin. Five patients underwent retroperitoneal open drainage and four patients CT-guided drainage. One patient with retroperitoneal perforated appendicitis was treated by laparotomy. Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli were the most common infective agents. There was no postoperative mortality and no cases of abscess recurred. CONCLUSIONS: CT scan is a diagnostic "gold standard" for psoas abscess. CT-guided drainage is the method of first choice, but is not possible in all cases. Open retroperitoneal drainage is a standard method of treatment. Postoperative antibiotic therapy is obligatory and should be adapted individually.     

Retroperitoneal abscess: 7-year experience of 29 cases in a tertiary care center in Taiwan

ObjectiveRetroperitoneal abscess is a rare condition with an insidious onset and difficult diagnosis. It can occur from various origins. To analyze our experiences, we conducted a case series study of retroperitoneal abscess cases in our hospital.Materials and methodsTwenty-nine patients in whom retroperitoneal abscesses were diagnosed at our hospital were reviewed from January 2007 to January 2014 for the purpose of analyzing the presenting symptoms, diagnostic tools, microbiology, treatment methods, and mortality.ResultsOf the 29 patients reviewed, a genitourinary origin was the most common source and accounted for 51.7% of the patients, and perinephric abscess was the main type of abscess. Diabetes mellitus, previous surgery, and an immunocompromised condition were common factors. The common clinical manifestations were fever (65.5%), back pain (37.9%), and abdominal pain (20.7%). Escherichia coli was the most prevalent pathogen (31.3%), followed by Klebsiella pneumoniae (25%). A polymicrobial pathogen accounted for 13.8% of infections. An anaerobic pathogen was only found in one case of gastrointestinal origin. Computed tomography and magnetic resonance imaging were found to be accurate diagnostic tools with sensitivities of 88.5% and 100%, respectively. Percutaneous drainage was commonly performed for abscesses of genitourinary origin, whereas surgical drainage was preferred in abscesses of gastrointestinal origin. The overall mortality rate was 3.4%, with one death reported.ConclusionRetroperitoneal abscesses exhibit an insignificant clinical manifestation and varied origin. Both computed tomography and magnetic resonance imaging were shown to be reliable tools for early diagnosis. K. pneumoniae was found to be a prevalent pathogen in the Taiwanese patients, especially in cases of perinephric abscess. The treatment methods for retroperitoneal abscess varied according to the origin and presentation.     

Retroperitoneal abscesses--analysis of a series of 66 cases

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.     

Retroperitoneal Abscess Resulting from Perforated Acute Appendicitis: Analysis of Its Management and Outcome

BACKGROUND: Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. MATERIALS AND METHODS: In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. RESULTS: Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. CONCLUSION: The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.     

Cases of pyogenic iliopsoas abscesses in military men

Four cases of pyogenic inflammation of the iliolumbar muscle were analyzed and 3 clinical cases of this disease in military men are described. A rare case of abscess of the iliolumbar muscle complicated by secondary appendicitis is also described. A hematogenic way of infection against the background of microtraumas and hematomas with m.Iliopsoas was the main one in the patients observed that was due to specificities of military service: permanent physical activity, pustular diseases of the lower extremities. The main clinical symptom of the disease is the symptom of the iliolumbar muscle. Ultrasonic scanning is the most informative method of diagnosis among additional methods. Operative treatment of the piogenic iliopsoas abscess is the only method of treatment, the open operative interventions by the retroperitoneal access being preferred. Antibacterial therapy in the postoperative period is based on the results of inoculation of the purulent discharge from the wound. Broad spectrum antibiotics must be used due to possible anaerobic character of the purulent inflammation.     

Percutaneous treatment of retroperitoneal abscesses

The retroperitoneal abscess is an uncommon disease, that must be treated by drainage. The progressive use of the percutaneous drainage, under ultrasound or computed tomography guidance (CT), has changed the therapeutical management and has demonstrated to be a valid alternative to surgical drainage. From 1986 to 1998, 16 patients with retroperitoneal abscesses were treated by percutaneous drainage (14 with CT and 2 with ultrasound guidance). This method eradicated the abscess in 13 cases, in 2 was necessary a new function to cure the abscess, and 1 patient, with a severe sepsis, died. Percutaneous drainage was the unique treatment used in 12 patients. In the remaining four, the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy. CONCLUSIONS: Percutaneous drainage of retroperitoneal abscesses has been established as a viable alternative to surgical intervention. This method can resolve the abscess or improve the patient' clinical status to undergo elective surgery.     

ERCP术后并发胰周及腹膜后脓肿的非手术处理

目的 总结ERCP术后并发胰周及腹膜后脓肿的非手术处理方法并评价其临床应用价值.方法 该组共收集2000年以来笔者遇到的5例ERCP后并发胰周及后腹膜脓肿的病人,所有病例均采用B超或CT引导下穿刺、于脓肿最低位处置人菊花头引流管引流.非手术处理还包括抗炎、抑酶药物的使用等.结果 所有病人均经引流等治疗后痊愈,引流时间在20～90 d不等,平均引流时间为52.4 d.总住院时间在35～165 d不等,平均91.8 d,无一例中转手术治疗.结论 穿刺引流术治疗ERCP术后造成的胰周脓肿或后腹膜脓肿安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点.穿刺点应尽可能选定在脓肿的最低位,可达到最佳的引流效果.     

ERCP术后并发胰周及腹膜后脓肿的非手术处理

目的 总结ERCP术后并发胰周及腹膜后脓肿的非手术处理方法并评价其临床应用价值.方法 该组共收集2000年以来笔者遇到的5例ERCP后并发胰周及后腹膜脓肿的病人,所有病例均采用B超或CT引导下穿刺、于脓肿最低位处置人菊花头引流管引流.非手术处理还包括抗炎、抑酶药物的使用等.结果 所有病人均经引流等治疗后痊愈,引流时间在20～90 d不等,平均引流时间为52.4 d.总住院时间在35～165 d不等,平均91.8 d,无一例中转手术治疗.结论 穿刺引流术治疗ERCP术后造成的胰周脓肿或后腹膜脓肿安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点.穿刺点应尽可能选定在脓肿的最低位,可达到最佳的引流效果.