扁桃体周围脓肿的细菌学培养及治疗

目的：探讨扁桃体周围脓肿的致病菌种类及临床治疗。方法，对1992—2000年共观察的86例PTA患，其中49例做细菌培养．在治疗上60例采取针吸排脓治愈，26例行扁桃体切除治愈．结果，49例RA穿刺脓掖培养结果，23例阳性(46．9％)，其中金黄色葡萄球菌10株(43．5％)，溶血性链球菌6株(26．1％)，草绿色链球菌及表皮葡萄球菌等其它菌7株(30．4％)．86例中60例经针吸排脓近期治愈2年内随访有中12例(20％)PTA复发，26例行扁桃体切除术随访未见复发．结论，RTA应用青霉素效果较好，疗程术少于2周．对初发PTA病人应采取针吸排脓治疗为主，只有少数在穿刺排脓治疗失败或有扁桃体切除适应证才行扁桃体切除术．     

扁桃体周围脓肿141例分析

<正>扁桃体周围脓肿是扁桃体周围间隙的一种化脓性感染。好发于青壮年。现就我院十年来收治的141例进行分析,报告如下。 1.临床资料 本组141例,男99例,女42例,发病年龄12～73岁,30岁以下80例(45.7％);病程3～30天,其中3～9天97例,10～30天44例;前上型134例,后上型7例。 治疗 全身给予抗生素及皮质类固醇激素;局部处理:单纯穿刺抽脓1～3次8例,脓肿自行破溃2例;切开排脓81例;扁桃体切除50例,其中脓肿时切除29例,切开排脓3～4天后切除14例,切开排脓2周后切除7例。 结果 扁桃体切除50例,均痊愈;单纯穿刺抽脓或自行破溃10例,2例复发,1例25天复发,1例3年后复     

脑脓肿的微创手术治疗

目的分析脑脓肿的手术疗效,探讨脑脓肿的微创外科治疗方法.方法根据术前评估和术中情况选择①脓肿抽吸和(或)引流;②脓肿完整切除或脓壁切开 刮除脓苔 脓壁全部/部分切除.结果手术死亡率为4.76%(3/63).无一例因脓壁切开手术引起感染扩散,所有患者术后CT复查显示病变均有不同程度地缩小和消失,获得随访45例术后神经功能良好.结论脓壁切开 刮除脓苔 脓壁全部/部分切除的方法能有效保留神经功能,符合微创手术理念.     

肾结石体外冲击波碎石术后梗阻性肾盂肾炎和肾积脓的诊治

目的 观察肾结石体外冲击波碎石术（ＥＳＷＬ）后的梗阻性肾炎和肾积脓的临床表现及预后。方法 回顾 性分析７８例肾结石患者ＥＳＷＬ后出现梗阻性肾盂肾炎、肾积脓的情况。结果 ７８例患者中６２例出现泌尿系感染症状，１６例则无症状；经积极处理后，有症状组只有１例（２％）需行肾输尿管全切除，明显低于无症状组的３例（１９％，Ｐ〈０．０１）。结论 肾结石ＥＳＷＬ后无症状性的肾盂肾炎和肾积脓危害严重，需引起重视。     

后腹腔镜肾切除术78例临床体会

目的:探讨后腹腔镜在肾切除治疗中的临床应用价值.方法:对78例患者行后腹腔镜肾脏切除术.单纯 肾切除51例,肾癌根治术14例,联合尿道电切镜肾输尿管全切除13例.肾脏肿瘤14例,结核性脓肾6例,上尿路结石(33例)、UPJO(3例)引起巨大肾积水并感染36例,开放手术后输尿管中、上段闭锁并肾积脓5例,无功能萎缩肾3例,...     

慢性盆腔炎-输卵管积脓38例诊治分析

目的:探讨慢性盆腔炎-输卵管积脓的临床特点,提高诊断率。方法:回顾分析38例慢性盆腔炎输卵管积脓患者的病史、临床表现及诊治经过。结果:术前确诊18例,术前诊断率为47.4%。子宫次全切加双侧附件切除8例,子宫次全切加双侧输卵管病灶切除6例,单纯输卵管病灶切除24例。结论:慢性盆腔炎-输卵管积脓临床表现多样化,需详细询问病史、查体、结合B超提高诊断准确率,腹腔镜检查是确诊的一个有效方法。手术治疗应根据患者年龄、对生育的要求决定手术范围。     

胆囊颈部结石胆囊积脓23例手术治疗体会

目的探讨胆囊颈结石嵌顿致胆囊积脓的病理变化及手术治疗方法。方法回顾性总结近年来本院23例胆囊颈结石嵌顿致胆囊积脓手术的临床经验。结果本组23例，胆囊大部分切除2例，其余21例均行胆囊切除，1例出现切口感染，均治愈出院。结论胆囊颈部结石嵌顿易发展致胆囊积脓，及时手术是根本的治疗方法。     

上尿路结石并发肾积脓的诊断和治疗

目的 提高上尿路结石并发肾积脓的诊治水平。方法 分析5例上尿路结石并发肾积脓患者的临床特点、诊断和治疗，并结合文献进行分析。结果 4例右侧结石并右肾积脓、1例双侧结石并左肾积脓、右肾萎缩者均经手术证实，其中2例行右肾切除，1例行右肾切开取石术 肾造瘘术，另2例行患侧输尿管切开取石术。结论 早期正确的诊断和合理的治疗是防治上尿路结石并发肾积脓和避免肾切除的关键。     

上尿路结石梗阻并发肾积脓肾功能损害的可逆性临床观察

我院1982年8月至1984年8月收治上尿路结石病人176例,其中并发肾积水35例,肾积脓8例,肾功能严重破坏者12例。8例并发肾积脓中,3例行肾切除,5例作保肾手     

保肾手术治疗脓肾的体会

目的 :探讨保肾手术治疗脓肾的方法。方法 :对 31例脓肾中的 19例行一期手术 ,12例术前行经皮肾造瘘引流 ,然后行二期手术。 31例术中在解除梗阻后留置输尿管内支架管 ,5例同时置肾造瘘管。结果 :2 8例术后获得良好疗效 ,1例住院期间需 2次手术切肾 ,2例随访期间因再发脓肾而行肾切除。结论 :如果处理方法得当 ,多数脓肾不需切肾。     

脾切除术后左上腹腔脓肿X线表现特征探讨

目的 探讨脾切除术后左上腹腔脓肿的类型及其Ｘ线表现特征。方法 观察分析我院２６例此手术证实的脾切除术后左上腹腔脓肿Ｘ线表现，所有病例均作了腹部平片，１３便作胃肠钡餐检查，１０例作脓腔或窦道造影。结果 ２６便中２３例均累及一个以上间隙，且脾窝均有受累。其中前外型４／２３例（１７．４％），后外型１２／２３例（５２．２％），网膜囊型７／２３例（３０．４％）Ｘ线表现与未切脾状态下左上腹腔脓肿的表现不同且与     

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33% of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics.     

Tropical liver abscess.

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.     

Postoperative subphrenic abscess following gastrectomy for gastric cancer

From 1985 to 1989, a total of 598 gastric cancer patients underwent gastrectomies in the First Department of Surgery at Kurume University School of Medicine. Of these, 24 patients (4.0%) incurred a subphrenic abscess, postoperatively. Subphrenic abscesses occurred most frequently after total gastrectomies at a rate of 17 of 197 (8.8%) cases. Leaking gastrointestinal anastomoses were responsible for 12 of the 17 (70.5%) abscesses. In 384 cases of distal gastrectomy, only 6 (1.6%) cases with a subphrenic abscess occurred, and only 3 were due to anastomotic leakage. Among the total of 24 cases with subphrenic abscesses, 16 (67%) were related to an anastomotic leakage including a pancreatic fistula, while the other 8 (33%) showed no leakage by contrast roentgenography. When chest roentgenography shows a pleural effusion and an elevation of the diaphragm, then a subphrenic abscess must be suspected. The majority of patients were treated by replacing the intraabdominal drainage catheter inserted during the gastrectomy with a larger catheter. The overall operative mortality rate was 4.1% due to a death in only one (MOF) patient.     

早期脊椎结核的MRI表现分析

目的：探讨早期脊椎结核的MRI表现,评价NRI反映早期脊椎结核病理特征的能力。方法：回顾11例经穿刺活检、临床抗结核治疗证实的早期脊椎结核的的MRI表现,结合x线等资料分析。结果：共26个病椎,其中5个“虫蚀状”骨质破坏,26个椎体合炎;U例椎体周围软组织肿胀,并椎旁、椎前脓肿4例;12M病椎椎间盘临近破坏终板裂隙状高信号5个,Gd-DTPA增强表现为裂隙状强化;病椎后硬膜外脓肿7例,Gd-DTPA增强后脓肿壁、后纵韧带线样强化。结论：椎体含炎、病椎虫蚀状骨质破坏、多个椎体周围软组织肿胀、T2WI椎间盘临近破坏终板裂隙状高信号、病椎后硬膜外脓肿、Gd-DTPA增强检查椎间盘裂隙状强化、后纵韧带强化等是早期脊椎结核富有特征性的MRI表现,MRI能较好地表达早期脊椎结核的病理变化。     

核磁共振成像在肛周感染性病变中的诊断价值

目的探讨核磁共振在肛周感染性疾病中的诊断价值。方法利用西门子公司3.0T核磁共振扫描仪,对我院2010年12月至2013年6月收治的60例拟诊肛周感染患者进行检查,依据病变位置、特征及MR图像进行分型,并与手术结果进行对照。结果 MR诊断单纯肛周软组织炎7例,单纯肛周脓肿7例,高位脓肿16例,复合脓肿30例,发现脓肿内口45个,与手术结果比较,MRI对脓肿符合率为100%,瘘管的符合率93.75%。对于脓肿及脓肿内口诊断MR诊断与术前肛诊有统计学意义。结论 MR对肛周感染性病变术前能准确诊断,特别是对于脓腔及脓肿内口诊断,为临床治疗方法的选择提供重要信息,具有很高的临床价值。     

Early detection of complications in amebic liver abscess.

A retrospective analysis of 140 cases with amebic liver abscess (ALA) seen at the AUNL University Hospital was done to see if patients with complications can be identified earlier in order to decrease morbidity and mortality. Sixteen patients (11.4%) presented complications and six patients died (4.2%). Patients with complications presented jaundice, large or multiple abscesses, acute abdomen, liver failure and sepsis more often than patients without complications. Hemoglobin, hematocrit, prothrombin time, total proteins, albumin, LDH, and BUN were more altered in patients who presented complications. The titer of antibodies against E. histolytica was higher in this group of patients. The six patients who died had been operated on. The causes of death were septic shock in two, sepsis in one, peritonitis in one, liver failure in one and colon perforation in one patient. Pleural effusion, jaundice and acute abdomen were seen in three patients, respectively (50%), two cases had multiple abscesses (33.3%), one patient had a ruptured abscess (16.7%). Patients who died exhibited more alterations in six laboratory examinations at admission: partial prothrombin time, total bilirubin, albumin, BUN, LDH, and leukocytes. Clinical data together with the severe alterations in laboratory examinations at admission for patients with ALA should alert the clinician to suspect complications earlier in order to decrease morbidity and mortality.     

脑立体定向活检术的临床应用与分析(附393例报告)

目的：研究采用CT/MRI引导下的立体定向技术对脑部病灶行立体定向活检术的方法和结果。方法：使用Leksell立体向定位头架。在CT/MRI引导下行立体定向穿刺活检。结果：肿瘤375例，脓肿15例，无病理结果3例（0.76%），活检总阳性率99.24%，肿瘤检出率95.42%，并发颅内出血2例（0.51%)，癫痫发作3例（0.76%)。无死亡病例，结论：脑立体定向活检术诊断阳性率高，安全、可靠，不权可达到定性诊断的目的，还可为下一步治疗提供可靠的病理学依据。     

经会阴高频超声与腔内超声联合应用在诊断肛周脓肿及瘘管形成中的价值

目的探讨经会阴高频超声与腔内超声联合应用在诊断肛周脓肿及瘘管形成中的价值。方法使用经会阴高频超声和（或）腔内端式探头对103例肛门直肠周围脓肿患者进行检查井艮据病变发生的解剖部位、声像图特征进行超声分型。结果检查肛管和直肠近端时,发现肛门直肠周围脓肿共108处,位于前半周者65处（6019％）,位于后半周者43处（3981％）,其中Ⅰ型29处。Ⅱ型26处,Ⅲ型28处,Ⅳ型25处;合并内外瘘形成的Ⅴ型56例,其中多发性瘘管形成26例,手术中诊断为合并内外瘘形成68例,超声诊断准确率为8235％。结论应用经会阴高频超声和（或）腔内探头检查肛门直肠周围脓肿,能够区分脓肿和肛周组织结构的关系,分辨多数肛瘘内外口所处的位置,为临床术式的选择提供可靠的诊断依据。     

磁共振成像诊断肛瘘误诊或漏诊分析

目的分析采用磁共振成像（magnetic resonance imaging, MRI）诊断肛瘘的误诊或漏诊病例情况。方法回顾性收集上海市静安区市北医院2018年6月至2019年6月经手术治疗的68例肛瘘患者临床及术前MRI资料。MRI扫描序列包括矢状位T2加权成像（T2WI）,斜轴位T1加权成像（T1WI）及薄层高分辨T2抑脂像（T2WI_SPAIR）,斜冠位T2WI及T2WI_SPAIR。其中29例增加了斜轴位弥散加权成像（DWI）,17例增加了斜轴位增强后T1抑脂像（CE THRIVE_FS）。MRI图像由2名未知手术结果的影像医师共同分析。MRI观察指标主要包括主瘘管及其Parks分型,瘘管内口及其位置,是否存在支管或伴发脓肿。以术中结果为标准,分析MRI诊断肛瘘的假阳性或假阴性表现。结果68例患者中,MRI对主瘘管及其Parks分型检出率为94.1%（64/68）,4例假阴性主要表现为瘘管液体含量少或处于慢性期,T2WI_SPAIR难以显示。瘘管内口检出率为70.9%（56/74）,其中5例假阳性主要原因是将黏膜皱缩或肛周小血管误认为内口,18例假阴性主要因为内口周围内括约肌肿胀或内口闭塞,T2WI_SPAIR难以识别。脓肿检出率为100%（27/27）。支管检出率为70.0%（21/27）,3例假阳性,6例假阴性,主要原因是支管细小。结论MRI诊断肛瘘误诊或漏诊主要表现在内口或支管的检出,增强对瘘管内口或支管的认识有望提高肛瘘的诊断准确性。