颈部深筋膜间隙脓肿20例临床分析

为探讨颈部深筋膜间隙脓肿的临床表现及切开引流的注意事项,本文将近10年20例分析报告于下。1 临床资料1.1 病例:20例中,男10例,女10例,年龄10个月～65岁。咽旁间隙脓肿11例,急性咽后脓肿4例,颌下间隙脓肿5例。1.2 临床表现:均有发热、局部肿疼。咽旁间隙脓肿者,患侧扁桃体及咽侧壁推向中线5例,患侧颈部、颌下弥漫性肿胀8例,有波动感3例,颈部强直5例。急性咽后脓肿4例中均有吞咽困难和咽后壁1例隆起,呼吸困难3例,头偏向1侧2例,颈部X线侧位片均见椎前隆起软组织阴影,椎骨骨质无破坏。颌下脓肿中,肿胀区波动感3例。1.3 治疗及结果:均作切开排脓,咽旁脓肿中2例作咽侧切开,9例行颈侧切开。急性咽后脓肿均行咽后壁切开。1例急性咽后脓肿并发喉水肿行气管切     

51例颈深部感染的临床诊治体会

目的:探讨颈深部感染的临床表现和诊治方法。方法:回顾性分析2014年12月-2017年12月本院收治的颈深部感染患者51例的临床资料,总结其发病特点及诊治方法。结果:51例患者中,30例扁桃体周围脓肿行切开引流术,其中5例同期行扁桃体切除术;1例咽旁脓肿及1例咽后脓肿行脓肿切开引流及气管切开;1例颌下间隙脓肿行穿刺抽脓;其他患者均经抗生素治疗。除1例合并多间隙脓肿患者转院,其余患者均治愈出院。结论:颈深部感染一旦形成脓肿,需尽早行切开引流,合并严重呼吸困难,需行气管切开术,用药宜选用广谱抗生素,必要时可联合用药。     

婴儿咽后壁脓肿4例误诊分析

咽后壁脓肿是咽后间隙急性化脓性感染,极易引起上气道梗阻,若没有得到及时诊治,会引起严重的呼吸困难,也会导致许多严重并发症如纵隔脓肿、食管气管瘘甚至致命性的大出血及颅内感染等[1]。现将我院4例被误诊的婴儿咽后壁脓肿病例报告如下,以引起儿科医生对该病的重视。     

小儿咽后壁脓肿2例麻醉体会

小儿咽后壁脓肿是危险性较大的疾病，随时可能破溃窒息死亡，麻醉手术风险较大，现将我科所遇2例报告如下。 例1：患儿，男，6月，体重7.5kg，因发热、咳嗽7d伴吞咽困难2d入院。入院查：咽后壁充血肿胀，有散在小脓点，心肺(-)。X线片示：咽后壁软组织肿胀明显，范围较广泛。术前诊断：咽后壁脓肿，拟行脓肿切开引流术。     

儿童急性咽后脓肿35例诊治探讨

目的:探讨儿童急性咽后脓肿的病因、诊断、治疗方法.方法:回顾性分析了我科1996年1月～2005年1月收治的35例咽后脓肿患者的临床资料.结果:34例患儿治愈出院,1例因并发纵膈脓肿、败血症死亡.结论:儿童咽后脓肿病情重,易误诊,X线及CT对诊断有重要意义,及时引流能缓解呼吸困难.     

颈深部脓肿患者的临床治疗及效果分析

  目的  探讨颈深部脓肿患者的临床表现和治疗情况,总结治疗经验,以期降低并发症,提高治疗水平。  方法  回顾性选择2018年1月—2021年10月蚌埠医学院第一附属医院耳鼻咽喉头颈外科治疗的22例颈部脓肿患者的临床资料,其中男性17例、女性5例。入院后积极予以广谱抗生素治疗或者手术治疗,观察患者临床特征、诊疗方法及效果。  结果  12例行颈侧切开脓肿引流,其中1例同时行胸腔镜胸腔脓肿清除;1例患者术前颈部CT及三维CT显示为扁桃体异物伴脓肿,行扁桃体切除术+咽部异物探查术,见扁桃体周脓性分泌物,未见异物,好转后出院观察;1例患者术前颈部CT显示为颈部异物伴咽后脓肿,本例插管困难,紧急行气管切开术,后行咽后脓肿切开引流+异物探查+食道镜探查,见大量脓液未见明显异物,好转后出院观察; 4例B超下穿刺持续引流,其中1例引流效果不佳并发脓毒血症放弃治疗;1例颈总动脉假性动脉瘤破裂后行修补;其余3例保守治疗。出院后随访1个月,除放弃治疗1例外其余21例均治愈且无复发。  结论  颈深部脓肿是耳鼻咽喉头颈外科的危急重症之一,术前诊断和紧急切开引流是治疗关键,诊断时应结合多种检查防止漏诊、误诊,必要时可行造影检查。呼吸困难者选择气管切开,全麻麻醉插管评估,合理使用抗生素,密切关注全身情况等在治疗中起到重要作用。      

小儿急性咽后脓肿的诊断与治疗

目的总结小儿急性咽后脓肿的诊治体会。方法回顾性分析8例小儿急性咽后脓肿患者的临床表现及治疗经过。结果5例首诊儿科并延误诊断。5例进行了颈部影像学检查，诊断准确率为100％。8例中6例经口内脓肿切开引流治愈；2例脓肿突然破裂，1例抢救后治愈，1例因全身感染中毒症状重而死亡。结论小儿急性咽后脓肿易被误诊，影像学检查有助提高诊断准确率，脓肿切开引流是最直接有效的治疗手段，倒提患儿是脓肿突然破裂时实用有效的急救措施。对于全身感染中毒症状较重的患儿，应及早行对症治疗。     

易被误诊为小儿肺炎的病例

肺炎是小儿常见病,以咳喘、肺部罗音为其特征。但临床上常遇到具有上述症状及体征而不是肺炎者,这些均属误诊病例。现将我院收治误诊为肺炎的临床病例介绍如下。一、咽后壁脓肿男,4个月。半月前发热轻咳,一周来咳喘呛奶,因双肺可闻喘鸣音在外院按肺炎住院治疗,经用抗生素五天病情未好转,因喘重而来我院。查体:呈明显吸气性呼吸困难伴鼾音。左颈淋巴结肿大,口腔、咽部有较多粘性分泌物,咽后璧呈半圆形隆起并充血。双肺布满喘鸣音,胸透正常。白细胞26,000/立方毫米,中性粒细胞81%.诊断为咽后壁脓肿,由耳鼻喉科医生予以切开引流后,呼吸困难很快消失。     

咽后脓肿14例临床回顾

目的:探讨咽后脓肿的临床特点,提高对该病的诊治水平。方法:直接喉镜引导下经口行咽后脓肿切开引流术,术后辅以全身抗炎治疗。结果:13例痊愈,1例放弃治疗,自动出院,无严重并发症发生。结论:对咽后脓肿应做到早期诊断,全身应用有效抗生素,及时切开引流,以提高治愈率,减少并发症的出现。     

急性咽后脓肿164例临床分析

目的 分析咽后脓肿发病的相关因素及各年龄组的临床特点,寻找预防措施和最佳处理方法。方法 回顾性分析急性咽后脓肿临床病例１６４例。结果 １５５例痊愈出院,５例症状明显好转,４例死亡。结果 咽后脓肿早期诊断,及时应用足量有效抗生素控制感染,及时经口切开引流,治愈率高。     

糖尿病合并细菌性肝脓肿的临床特点及外科治疗

目的：探讨糖尿病合并细菌性肝脓肿的临床特点、诊断及外科治疗。方法：对外科治疗的32例糖尿病合并细菌性肝脓肿患者作回顾性分析。结果：有典型症状者仅14例,不典型症状者18例;好发于血糖控制不良的患者;脓液细菌培养阳性率较低。单纯用抗生素治疗10例,B超引导经皮肝穿刺置管引流8例,手术治疗14例,治愈29例,死亡3例,主要死因为多器官功能衰竭。结论：糖尿病合并细菌性肝脓肿临床表现不典型,诊断首选B超检查,在严格控制血糖,加强营养支持,选择合适治疗方案完全可以达到理想的外科治疗效果。     

19例糖尿病合并细菌性肝脓肿临床诊疗分析

目的:总结分析糖尿病合并细菌性肝脓肿(DLA)的临床特点,并探讨其诊疗策略。方法:对19例糖尿病合并细菌性肝脓肿(DLA)患者的临床资料进行回顾性归纳分析。观察指标包括临床表现、并发症、实验室检查、病原学检查、脓肿分布以及治疗方法和疗效。结果:19例DLA均为2型糖尿病患者,多见于血糖控制不良的老年人。临床表现不典型,明显腹痛并不常见(26.3%),细菌培养阳性率低(36.8%)。B超、CT等影像学检查意义重大。单纯抗生素治疗13例,B超下脓肿穿刺5例,外科脓肿切开引流1例。18例康复,治疗总有效率达94.8%。结论:糖尿病合并细菌性肝脓肿临床表现复杂,并发症多,易漏诊、误诊。早期诊断、用胰岛素控制血糖、早期足量应用有效抗生素及适时脓肿引流是成功治疗的关键。     

Psoas abscess as a complication of subclavian venous catheterization

A 76 year old woman developed a psoas abscess from vascular seeding of an infected subclavian venous catheter. The presentation was insidious and diagnosis delayed. Despite adequate surgical drainage, the case proved to be fatal. Venous catheters should be regarded as a potential source of septicaemia and occult abscess formation.     

A ten year retrospective review of orbital complications secondary to acute sinusitis in children

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.     

垂体脓肿的临床特点及手术治疗

目的探讨垂体脓肿的临床特征和手术治疗。方法4例垂体脓肿患者均行手术治疗。分析4例患者的临床特征和诊疗过程。结果男2例,女2例,年龄15～51岁,主要症状为头痛、视力减退、垂体功能低下、尿崩症等。4例患者均行手术,复发者再次手术治疗,术后恢复良好。结论早期诊断和及时采用经蝶手术、术后予合理足程的抗生素及激素替代治疗,是改善垂体脓肿预后、提高患者生存率的关键。     

高负压引流系统治疗小儿颈部脓肿及减少术后瘢痕的研究

目的：探讨一次性闭合高负压引流系统(high negative pressure drainage system,PFM)治疗小儿颈部脓肿及减 少术后疤痕的临床意义。方法：对2012年6月至2014年l月收治的35例颈部脓肿患儿的临床资料进行回顾性分析。根据 患儿脓肿的部位分别采用小切口脓肿切开排脓联合一次性闭合PFM术后持续引流术,同时应用抗生素,加强全身支持 疗法;对并发的各种基础疾病请相关科室协同处理,术后使用去疤硅酮凝胶外用手术切口3~6个月。结果：35例患儿 治疗7~14 d皆痊愈,脓肿有效治愈率100%,术后随访6个月至1年,手术切口处无明显疤痕形成。结论：小切口脓肿切 开排脓联合一次性闭合PFM术后持续引流术表现出微创治疗的优越性,术后无需更换脓腔内引流纱条,无需更换引流 瓶,患儿生理活动不受影响,能明显减轻换药给患儿带来的痛苦和医师的工作量,愈合快,可缩短住院时间,且愈 合后无明显瘢痕,外观无异常,尤其针对深部且较大的脓肿效果更好,治疗效果优于传统治疗方法。     

Renal and Perinephric Abscesses Revisited

Background

This study was carried out to assess the spectrum of renal and perinephric space infection among urology patients admitted in the last three years.

Methods

Medical records of patients with renal and perinephric abscess and emphysematous pyelonephritis were reviewed. Results: Out of 2278 patients admitted in last three years, 29 (1.2%) patients suffered from renal and perinephric space infection, 13 (45%) patients had renal abscess, 11 (38%) perinephric abscess and five (17%) emphysematous pyelonephritis. Sixteen (55%) patients recovered conservatively, nine (31%) patients required percutaneous drainage of the abscesses and remaining four (14%) underwent surgical exploration. The overall mortality was 14% in this study.

Conclusion

Renal and perinephric space infection continues to be a serious urological problem with high mortality rate. A high index of suspicion, prompt diagnosis, appropriate antibiotics and surgical intervention may be effective in reducing mortality.Key Words: Renal abscess, Perinephric abscess, Emphysematous pyelonephritis, Xanthogranulomatous pyelonephritis     

Bilateral orbital complications of paediatric rhinosinusitis

Background

The spread of infection from the ethmoid sinuses to the orbit occurs directly through a congenital dehiscence of the lamina papyracea or via haematogenous spread through ophthalmic venous system. Hence orbital complications of paediatric rhinosinusitis are usually unilateral at presentation.

Methods

We describe three children with bilateral orbital cellulitis that occurred as a complication of rhinosinusitis without intracranial spread of the infection. The children ranged in the age group from 4 to 7 years. All these children had a prolonged hospital stay from 14 to 25 days and underwent multiple surgical procedures to drain the subperiosteal abscess. These children presented to the hospital with bilateral orbital cellulitis without significant past history. All of them on radiological evaluation showed subperiosteal abscess involving only one orbit. They were taken up for functional endoscopic sinus surgery and the subperiosteal abscess was drained endoscopically with partial removal of lamina papyracea. One case required second surgery despite good recovery for two days post first surgery.

Result and conclusion

Two cases had severe unilateral visual loss at presentation but both recovered dramatically after the surgery. All cases had uneventful recovery with no residual disability. The purpose of this article is to discuss the reasons for bilateral orbital complications of rhinosinusitis at initial presentation despite the previous hypothesis of unilateral involvement.     

Solitary liver abscess: a continuing medicosurgical problem.

The management problems of 22 patients with solitary liver abscess are reviewed. To achieve earlier diagnosis, and reduce the high mortality rate of this condition (32% in this series), clinicians need to change their data base of the clinical presentation and also to incorporate liver imaging as part of the routine investigation of a patient with pyrexia of uncertain origin. The problems associated with operative diagnosis, and with methods of surgical drainage are discussed. The need for careful bacteriological cultures is emphasized, and the use of the most appropriate antibiotics is described. While in many cases the cause of the liver abscess remains unknown, in Australia the possibility of the abscess being amoebic or an infected hydatid cyst should be kept in mind.