小儿阑尾周围脓肿的治疗

小儿阑尾周围脓肿的治疗方法包括保守治疗及手术治疗,两种方法各有利弊。广西省北海市人民医院2002年至今收治126例,现报告如下。     

儿童阑尾周围脓肿腹腔镜Ⅰ期手术疗效分析

目的:探讨运用腹腔镜Ⅰ期阑尾切除术治疗儿童阑尾周围脓肿的临床疗效。方法:收集2017年5月至2020年4月在福建医科大学附属漳州市医院接受腹腔镜Ⅰ期阑尾切除术治疗的269例儿童复杂性阑尾炎患儿的相关资料。其中,男181例,女88例;将45例儿童阑尾周围脓肿患儿作为A组,224例同期收治的其他复杂阑尾炎(化脓性、坏疽性或...     

小儿阑尾脓肿的手术治疗

目的 探讨小儿阑尾脓肿的治疗。方法 110例小儿阑尾脓肿患儿,66例行阑尾切除术及腹腔冲洗,8例单纯腹腔引流,5例直肠引流,31例保守治疗。结果 阑尾切除组、腹腔引流组、经直肠引流组和保守治疗组平均住院日分别为10.3d、11.5d、12.4d,15d。66例行阑尾切除全部治愈,无肠漏及肠梗阻发生。结论 小儿阑尾脓肿可行I期阑尾切除术。     

儿童阑尾周围脓肿保守治疗后管理方式的选择

儿童阑尾炎并发阑尾周围脓肿的治疗方式一直存在争议。在急性阑尾炎并发阑尾周围脓肿的病例中, 当患儿出现弥漫性腹膜炎和全身中毒症状时首选急诊手术治疗。除此之外, 保守治疗广泛应用于并发阑尾周围脓肿患儿的早期治疗中。大量研究证实了保守治疗的安全性和有效性, 成功率高达80%～97%, 并且保守治疗成功后, 复发概率较低, 约2%～34%。本研究对儿童急性阑尾炎并发阑尾周围脓肿的保守治疗及好转后管理方式的选择进行综述, 建议保守治疗好转后的管理方式可优先选择积极随访观察, 不必常规进行择期阑尾切除术, 存在复发风险因素的患儿需提高警惕或建议择期阑尾切除术。     

新生儿阑尾周围脓肿2例

新生儿阑尾周围脓肿较为罕见,临床表现常常不典型,早期诊断较为困难,误诊率极高。我院近年来收治新生儿阑尾周围脓肿2例。现报告如下。     

小儿阑尾周围脓肿61例临床分析

目的总结19年来北京大学第一医院对于小儿阑尾周围脓肿的治疗经验,探讨治疗策略的变化。方法回顾性分析自1993年至2011年间,作者收治的61例阑尾周围脓肿患儿临床资料。治疗方法包括静脉输入抗生素、理疗、B超引导下脓肿穿刺及手术治疗。结果保守治疗32例,1例于4周后发生肠梗阻,1例1年后再发脓肿;B超引导下行脓肿穿刺4例,无并发症;手术25例（10例行脓肿切开引流并切除阑尾,其余行脓肿切开引流）,出现并发症（切口感染、肠梗阻、残余脓肿）11例。4例于随访期间发作急性阑尾炎,予手术切除阑尾,其中3例存在阑尾粪石。结论对于阑尾周围脓肿,应首选以静脉输入抗生素为主的保守治疗方法;对于部分脓肿较大的患儿,可在B超引导下行穿刺引流。存在阑尾粪石的患儿,应行二期阑尾切除术。     

新生儿阑尾周围脓肿一例

患儿 :女 ,2 8ｄ。因腹胀、肛门停止排气排便 14ｄ在院外行胃肠减压、补液抗炎等治疗无效转入我院。患儿双胎 ,孕 2 8周早产 ,出生体重 1.85ｋｇ,产后胎便排出正常。检查 :神清 ,哭声弱 ,苍白面容 ,Ｔ 36 .8℃ ,Ｐ 14 4次 /ｍｉｎ ,Ｒ 4 4次 /ｍｉｎ ,心肺未见异常 ,腹膨隆 ,未见胃肠型及胃肠蠕动波 ,轻度腹肌紧张 ,未见压痛、反跳痛 ,移动性浊音可疑 ,肠鸣音弱 ,右下腹可扪及一 4ｃｍ× 3ｃｍ× 3ｃｍ左右包块 ,质中 ,界欠清 ,不能推动 ,肛门指检(- )。ＷＢＣ 12 .1× 10 9/Ｌ ,Ｎ 0 .74 ,Ｌ0 .2 0 ,Ｈｂ 91ｇ/Ｌ,Ｐｌｔ 2 2 4× 10 9/Ｌ ,…     

儿童阑尾穿孔的治疗体会

目的 探讨儿童阑尾穿孔治疗经验体会。方法 作者回顾性分析了1995年～2001年上海新华医院和上海儿童医学中心近6年的儿童阑尾穿孔的临床资料。对比根据术中脓液培养结果来选择相对应的抗菌素，以及采用经验性广谱抗菌素。结果 共有219例作Ⅰ期阑尾切除术。对比前后3年的二组患儿，在住院时间、术后发热持续时间、抗菌素使用时间和其它腹腔内的并发症，两者没有明显的区别。结论 对典型的阑尾穿孔应尽早手术。经验性的广谱抗菌素足够覆盖正常的肠道菌群，预防术后并发症的发生。对阑尾脓肿，应在可能的情况下，行Ⅰ期阑尾切除。     

儿童阑尾脓肿的腹腔镜治疗

目的 探讨腹腔镜在小儿阑尾脓肿诊治中的价值.方法 回顾性分析近3年来安徽省立儿童医院儿外科收治的128例小儿阑尾脓肿行腹腔镜手术的患儿临床资料.结果 128例中,121例顺利完成手术,7例中转开腹手术,其中5例切除阑尾,2例仅行引流.术中发现2例合并美克尔憩室,予切除;1例出现粪瘘,经B超引导下置管引流获痊愈;4例术...     

小儿阑尾脓肿手术治疗20例临床体会

目的通过对小儿阑尾脓肿I期行阑尾切除术,总结外科手术治疗要点及适应证。方法收集本院7年内收治小儿阑尾脓肿52例,其中20例行手术治疗,I期行阑尾切除术。腹腔内用0.5％聚维酮碘生理盐水彻底冲洗并置管引流。术后用第三代头孢菌素,氨基糖甙类及抗厌氧菌类抗菌素抗炎治疗。结果除1例因并直肠穿孔行造瘘外余均恢复良好,平均住院11d,无肠瘘等并发症发生。结论 急性阑尾炎是小儿外科常见疾病,但由于其临床症状不典型,容易误诊而形成阑尾脓肿,按常规方法阑尾脓肿经保守治疗症状无明显好转,脓肿继续增大时应及时切开脓腔置管引流,但我院经对20例阑尾脓肿手术治疗,体会到只要掌握适应证、处理恰当,可以I期行阑尾切除术,以避免患儿第二次手术所带来的痛苦。     

92例小儿颅脑损伤手术治疗的体会

目的 探讨小儿颅脑损伤的手术治疗方法。方法 对92例小儿颅脑损伤进行手术治疗，其中颅骨骨折18例，硬膜外血肿26例，硬膜下血肿11例，复合血肿并脑挫伤37例。结果 预后良好81例，中度残疾5例，植物生存1例，死亡5例。结论 对小儿颅脑损伤应及早诊断，及时处理，及时手术，术后采取积极的综合治疗。     

Pathology of Pyogenic Liver Abscess in Children

Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children. Received August 17, 1998; accepted January 4, 1999.     

Experience and Outcome of Children with Severe Acute Malnutrition Using Locally Prepared Therapeutic Diet

Objective

Globally more than 1/3rd of the child deaths are attributed to under nutrition and it continues to be a major public health problem in developing countries. This research paper is an attempt towards intervention and management of severely malnourished children with the use of locally prepared therapeutic diets to bring down the case fatality rate.

Methods

A cross-sectional longitudinal study was undertaken at a tertiary care hospital in North India. Children under 5 y of age fulfilling the WHO case definition of severe acute malnutrition and suffering from medical complications were enrolled and managed on standard WHO protocols using locally prepared therapeutic diet (Starter F-75 diet and Catch-up F-100 diet).

Results

During the period of 11 mo, a total of 315 children (192 boys and 123 girls) under 5 y with severe acute malnutrition requiring in-patient care were enrolled and evaluated. The overall case fatality rate was 3.5 % while average weight gain seen was 9.33?±?8.28 g/kg body weight/day and average length of stay was 11.71?±?7.59. The Nutrition Rehabilitation Centre (NRC) observed a cure rate of 47 % and secondary failure rate of 19 %.

Conclusions

The present study highlights the integral role of locally prepared therapeutic diet (starter F-75 and F-100) besides standardized care provided at Nutrition Rehabilitation Centre (NRC) to combat malnutrition which is a major scourge in the developing world. To sustain the benefits and prevent relapse, there is a need to integrate the services at NRC with the community-based therapeutic care to deliver continuum of care from facility to door step and vice versa.

     

小儿细菌性肝脓肿的诊断及治疗

目的：为了提高小儿细菌性肝脓肿的疗效。方法：对３３例小儿细菌性肝脓肿进行回顾性分析。男２４例，女９例，平均年龄６岁。结果：右肝脓肿２４例，左肝脓肿９例，脓腔最大１５ｃｍ×１２ｃｍ×１０ｃｍ，最小２．５ｃｍ×２．０ｃｍ×１．５ｃｍ。非手术治疗１８例，占５４．５％；经皮穿刺置管疗法６例；经腹行脓肿切开引流术９例。全部病例均治愈。结论：１．肝脓肿的诊断除临床表现外，首选彩超；２．根据肝脓肿的分期及部位而选择不同的治疗方法     

微孔腹腔镜治疗先天性肥厚性幽门狭窄的体会

目的探讨微孔腹腔镜治疗先天性肥厚性幽门狭窄的优越性。方法采用1个5mm电视腹腔镜微孔、2个3mm操作微孔行幽门环肌切开术16例。结果微孔腹腔镜手术无1例中转开腹，平均手术时间25min。术后12h拔除胃管，开始少量喂奶，无手术并发症发生。结论腹腔镜幽门环肌切开手术与开腹手术相比有一定的优越性，手术打击小，切口小，术后恢复快，手术瘢痕小，外观美观，患儿家长易接受。     

急性阑尾炎穿孔并盆腔脓肿的治疗

目的　探讨急性阑尾炎穿孔并盆腔脓肿的治疗方法。方法　 2 0 0 0年 1月～ 2 0 0 4年 9月对 14例小儿急性阑尾炎穿孔并发盆腔脓肿行经肛门直肠前壁套管针穿刺引流 ,术后配合超短波理疗治疗。结果　 14例均经一次穿刺引流痊愈 ,引流脓液 10～ 40 0mL。结论　经肛门直肠前壁套管针穿刺引流治疗盆腔脓肿 ,方法简单、易行 ,损伤小 ,效果好。