细菌性肝脓肿合并糖尿病的临床特征

目的 比较伴或不伴糖尿病的细菌性肝脓肿(BLA)的临床特征差异,为临床诊疗提供参考.方法 回顾性分析2016年1月至2020年1月期间南京医科大学附属淮安第一医院收治的BLA患者的临床资料,比较伴或不伴糖尿病BLA患者在临床症状及体征、实验室检查结果、影像学表现、病原学检查结果以及治疗方法和转归方面的差异.结果 本研究...     

糖尿病合并细菌性肝脓肿的诊断和治疗

目的：探讨糖尿病合并细菌性肝脓肿的临床特点,以提高治疗水平。方法：对54例患者的临床资料进行回顾性分析。结果：糖尿病合并细菌性肝脓肿不明感染源者63．0％。有典型症状者仅53．7％。并发感染性休克和急性肾功能不全者各5例,酮症酸中毒和高渗性昏迷各2例,肝脓肿溃破而致腹膜炎1例。单纯用抗生素治疗者20例,B超引导经皮肝穿刺置管引流17例,手术治疗17例。治愈51例（94．4％）,死亡3例。结论：糖尿病合并细菌性肝脓肿发病隐匿,严重并发症多,易误诊误治。早期诊断、控制血糖、适时脓肿引流和有效抗生素应用是治疗成功的关键。     

糖尿病合并细菌性肝脓肿的诊断与治疗

肝脏受到感染后,常易继发细菌性肝脓肿。细菌性肝脓肿系由细菌经过胆道、肠道等多种途径所导致的肝内化脓性感染,胆道感染、胆结石、血行感染或肝外伤等皆可引起[1]。随着治疗方案的进一步规范及高效广谱抗生素的应用,上述原因导致的肝脓肿发病率呈逐渐下降趋势。糖尿病是细菌性肝脓肿的重要易患因素[2]。由于社会经济的发展、生活水     

糖尿病合并细菌性肝脓肿424例临床分析

目的:分析糖尿病合并细菌性肝脓肿患者的临床特征、病原学特性、治疗和转归,为临床诊疗提供参考。方法:回顾性分析2016年1月至2020年12月在温州医科大学附属第一医院、永嘉县人民医院和永嘉县中医院确诊住院的糖尿病合并细菌性肝脓肿患者临床资料,包括性别、年龄、基础疾病、症状、体征、住院时间、住院次数、实验室检查指标、病原...     

微创技术结合中药治疗细菌性肝脓肿45例

细菌性肝脓肿在临床并非少见。1999年4月—2010年8月,我院采用微创技术结合中药治疗45例,现报告如下。1临床资料本组45例,男32例,女13例;平均年龄51岁,其中60岁以上老年患者18例。45例患者多表现为发热和右上腹疼痛或伴有恶心、食欲减退等,其中合并糖尿病18例,胆石症6例。     

合并有糖尿病的细菌性肝脓肿诊治经验

目的: 总结合并糖尿病的细菌性肝脓肿的诊治经验.方法: 回顾性分析35例糖尿病合并细菌性肝脓肿患者的临床资料.结果: 糖尿病合并细菌性肝脓肿占同期收治细菌性肝脓肿的50%.高龄糖尿病患者是细菌性肝脓肿的高发人群,右上腹痛、寒战高热、右上腹压痛与肝区叩痛是其主要临床表现,绝大多数患者的血常规检查为炎症表现.影像学诊断应首选B超检查,大部分细菌性肝脓肿可在B超引导下经皮肝脓肿穿刺置管引流而治愈.结论: 糖尿病患者并发肝脓肿近来有增多的趋势,多见于高龄患者.提高认识,仔细查体,综合分析,是提高确诊率的关键.     

糖尿病并细菌性肝脓肿的临床分析

目的总结糖尿病并细菌性肝脓肿(DPHA)的临床特点和诊治经验。方法回顾性分析我院2002年3月至2010年12月期间出院的DPHA与无DPHA(NDPHA)患者的临床资料。结果细菌性肝脓肿患者共22例,其中DPHA患者11例。DPHA组人口学特征、临床表现、白细胞计数与NDPHA组比较差异均无统计学意义(P>0.05);DPHA组血白蛋白低于NDPHA(P=0.006),而ALT高于NDPHA(P=0.006)。DPHA组病灶个数多于NDPHA组(P=0.032),且病灶直径也大于NDPHA组(P=0.006)。脓培养:2组大肠杆菌均为3例;DPHA组克雷伯杆菌4例,而NDPHA组无克雷伯杆菌。DPHA组发生切口感染7例、腹腔感染2例,NDPHA组发生切口感染3例。DPHA组抗生素使用时间、住院时间及住院费用均高于NDPHA组(P<0.05)。2组均分别治愈6例、好转5例,2组均无死亡患者。结论 DPHA有其特殊的临床特征,并发症多,住院费用高,但预后与NDPHA差别不大。     

糖尿病病人合并细菌性肝脓肿的临床特点(附42例报告)

目的　总结糖尿病病人合并细菌性肝脓肿的临床特点和治疗经验。方法　回顾性分析 42例糖尿病病人合并细菌性肝脓肿临床资料,并与同期收治非糖尿病肝脓肿病人比较。结果　糖尿 病病人合并肝脓肿脓液细菌培养阳性率、脓腔大小、住院时间与非糖尿病肝脓肿病人比较有显著性差 异,而治愈率无差异。结论　糖尿病肝脓肿病人主要为隐源性肝脓肿,常见致病菌为肺炎克雷白杆 菌,治疗应强调有效控制血糖、合理应用抗生素、全面营养支持和脓腔个体化治疗,可使预后与非糖尿 病肝脓肿病人无差异。     

糖尿病合并细菌性肝脓肿30例临床诊治分析

目的 探讨糖尿病合并细菌性肝脓肿（DPHA）的临床特点及诊治经验。方法对30例DPHA患者的临床资料进行回顾性分析。结果DPHA患者30例,均为2型糖尿病,明显腹痛并不常见,普遍存在肝功能损害及细菌培养阳性率低,治疗后痊愈11例（36．7％）,有效18例（60．O％）,总有效率为96．7％。结论早期诊断是改善本病预后的关键。DPHA症状多不典型,且多无明确诱因,治疗应以控制感染、处理脓肿为主,方案个体化,兼顾血糖控制及营养支持治疗。     

糖尿病合并细菌性肝脓肿患者介入治疗的护理

对10例糖尿病合并细菌性肝脓肿患者在CT导向下经皮肝穿刺行介入治疗,术前精心准备．术中做好体位护理和病情观察,术后进行并发症观察、及时对症护理,加强引流管护理,结果所有患者顺利完成治疗,康复出院。     

多元化微创技术在重症急性胰腺炎治疗中的应用

目的 探讨多元化微创技术在重症急性胰腺炎(SAP)治疗中的临床应用价值.方法 回顾性分析2005年1月至2010年7月哈尔滨医科大学附属第一医院收治的93例接受微创治疗的SAP患者的临床资料,根据患者的病情,分别采用超声引导下经皮穿刺置管(PCD)、ERCP、EST和(或)ENBD、腹腔镜等治疗,总结其临床疗效.结果 本组患者在综合治疗的基础上联合1种微创技术治疗32例,2种微创技术治疗41例,3种微创技术治疗14例,4种微创技术治疗6例.69例患者施行超声引导下PCD;28例施行ERCP、EST和(或)ENBD;29例施行腹腔镜手术;19例施行分阶段处理;4例发生腹腔出血并发症的患者施行介入治疗.本组患者平均腹痛缓解时间为(37±18)h;平均住院时间为(31±21)d;胰周感染发生率为62％ (58/93);中转开腹率为4％ (4/93);治愈率为91％( 85/93);病死率为9％(8/93).结论 采用多种微创技术联合个体化治疗,可明显提高SAP的治愈率.     

Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children

Purpose

The aim of the study was to evaluate outcomes after a minimally invasive approach to pediatric subcutaneous abscess management as a replacement for wide exposure, debridement, and repetitive packing.

Methods

A retrospective study was performed of all children who underwent incision and loop drainage for subcutaneous abscesses between January 2002 and October 2007 at our institution.

Technique

Two mini incisions, 4-5 mm each, were made on the abscess, as far apart as possible. Abscess was probed, and pus was drained. Abscess was irrigated with normal saline; a loop drain was passed through one incision, brought out through the other, and tied to itself. An absorbent dressing was applied over the loop and changed regularly.

Results

One hundred fifteen patients underwent drainage procedures as described; 5 patients had multiple abscesses. Mean values (range) are as follows: age, 4.25 years (19 days to 20.5 years); duration of symptoms, 7.8 days (1-42 days); length of hospital stay, 3 days (1-39 days); duration of procedure, 10.8 minutes (4-43 minutes); drain duration, 10.4 days (3-24 days); and number of postoperative visits, 1.8 (1-17). Bacterial culture data were available for 101 patients. Of these, 50% had methicillin-resistant Staphylococcus aureus, 26% had methicillin-sensitive Staphylococcus aureus, and 9% streptococcal species. Of the 115 patients, 5 had pilonidal abscesses, 1 required reoperation for persistent drainage, and 1 had a planned staged excision. Of the remaining 110 patients, 6 (5.5%) required reoperation—4 with loop drains and 2 with incision and packing with complete healing.

Conclusion

The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this minimally invasive technique as the treatment of choice for subcutaneous abscesses in children and consider it the standard of care in our facility.     

影像引导机器人系统在微创治疗的临床应用进展

影像引导的微创治疗技术在临床诊疗工作中发挥着越来越重要作用。随着科技进步,影像引导机器人技术逐步成熟,并可完成一定的临床微创治疗工作,弥补了手术过程中的诸多不足。本文主要对影像引导机器人系统的发展现状及其在微创治疗中应用进行综述。     

慢性肾功能不全患者微创经皮肾镜取石术后的中期随访研究

目的 随访观察慢性肾功能不全患者行微创经皮肾镜取石术后的肾功能情况,探讨预测术后肾功能恶化的指标.方法 选取2009年1月至2011年12月因肾结石或输尿管上段结石行微创经皮肾镜取石术患者78例,术前预计肾小球滤过率(estimated glomerular filtration rate,eGFR)为(38.4±12.8)ml/(min·1.73m2).术后随访1年,将患者分为肾功能好转或维持不变组(第1组)和肾功能恶化组(第2组).第1组:男41例,女25例,年龄(42.8±16.3)岁;第2组:男7例,女5例,年龄(45.3±14.2)岁.第1组体质指数(BMI) (24.3±4.1)kg/m2、第2组(25.4±5.2) kg/m2.高血压病患者第1组35例,2组10例;糖尿病患者第1组15例,第2组7例;开放手术史第1组19例,第2组4例;ESWL史第1组19例,第2组4例.轻度肾积水第1组22例,第2组4例;中度或重度肾积水第1组44例,第2组8例.鹿角形结石第1组22例,第2组7例.第1组术中单通道53例,多通道13例;第2组术中单通道10例,多通道2例.第1组手术时间为(78.2±30.4)min,第2组为(80.3±32.3) min.结果 本组78例术后1个月复查CT平扫发现结石完全清除67例,其中第1组56例,第2组11例,清除率为85％.术后1年eGFR平均为(45.1±15.8)ml/(min·1.73m2),与术前比较差异有统计学意义(P＜0.05).肾功能好转24例(31％),维持不变42例(54％),下降12例(15％).通过多因素回归分析发现,糖尿病是预测微创经皮肾镜取石术后肾功能恶化的重要因素(OR=3.85,P＜0.05).结论 肾功能不全患者微创经皮肾镜取石术后,85％的患者在1年随访期间内肾功能好转或者维持不变.微创经皮肾镜取石术对于肾功能不全的结石患者是一种安全有效的治疗手段.研究结果显示糖尿病是预测术后肾功能恶化的指标,对于合并糖尿病的结石患者行微创经皮肾镜取石术后需要积极的血糖监测和治疗.     

肝胆结石腹腔镜微创治疗的效果观察

目的探讨腹腔镜微创治疗肝胆结石的效果。方法将70例肝胆结石患者随机分为观察组与对照组2组,每组35例。观察组实施腹腔镜下微创手术治疗,对照组实施传统开放手术治疗,对比2组的手术情况、术后康复情况及并发发生情况。结果观察组术中出血量显著少于对照组,且手术时间、术后肛门排气时间以及住院时间均较对照组显著缩短,比较差异均有统计学意义(P0.05);观察组需使用镇痛剂例数及结石残留率均显著低于对照组,比较差异均有统计学意义(P0.05)。结论腹腔镜微创治疗肝胆结石创伤小、疗效确切、术后恢复快且并发症少,是一种较为安全可靠的手术方式,值得在临床中推广应用。     

Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion

Study design

Prospective observational cohort study.

Objective

Comparison of clinical and radiological outcomes of single-level open versus minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) at 6 months and 2-year follow-up.

Summary of background data

There is recognition that more data are required to ascertain the benefits and risks of MIS vis-a-vis open TLIF. This study aims to report on one of the largest currently available series comparing the clinical and radiological outcomes of the two procedures with a minimum follow-up of 2 years.

Methods

From January 2002 to March 2008, 144 single-level open and MIS TLIF were performed at our centre, with 72 patients in each group. Clinical outcomes were based on patient-reported outcome measures recorded at the Orthopaedic Diagnostic Centre by independent assessors before surgery, at 6 months and 2 years post-operatively. These were visual analogue scores (VAS) for back and leg pain, Oswestry disability index (ODI), short form-36 (SF-36), North American Spine Society (NASS) scores for neurogenic symptoms, returning to full function, and patient rating of the overall result of surgery. Radiological fusion based on the Bridwell grading system was also assessed at 6 months and 2 years post-operatively by independent assessors.

Results

In terms of demographics, the two groups were similar in terms of patient sample size, age, gender, body mass index (BMI), spinal levels operated, and all the clinical outcome measures (p > 0.05). Perioperative analysis revealed that MIS cases have comparable operative duration (open: 181.8 min, MIS: 166.4 min, p > 0.05), longer fluoroscopic time (open: 17.6 s, MIS: 49.0 s, p < 0.05), less intra-operative blood loss (open: 447.4 ml, MIS: 50.6 ml, p < 0.05) and no post-operative drainage (open: 528.9 ml, MIS: 0 ml, p < 0.05). MIS patients needed less morphine (open: 33.5 mg, MIS: 3.4 mg, p < 0.05) and were able to ambulate (open: 3.4 days, MIS: 1.2 days, p < 0.05) and be discharged from hospital earlier (open: 6.8 days, MIS: 3.2 days, p < 0.05). At 6 months, clinical outcome analysis showed both groups improving significantly (>50.0 %) and similarly in terms of VAS, ODI, SF-36, return to full function and patient rating (p > 0.05). Radiological analysis showed similar grade 1 fusion rates (open: 52.2 %, MIS: 59.4 %, p > 0.05) with small percentage of patients developing asymptomatic cage migration (open: 8.7 %, MIS: 5.8 %, p > 0.05). One major complication (open: myocardial infarction, MIS: screw malpositioning requiring subsequent revision) and two minor complications in each group (open: pneumonia and post-surgery anemia, MIS: incidental durotomy and pneumonia) were noted. At 2 years, continued improvements were observed in both groups as compared to the preoperative state (p > 0.05), with 50.8 % of open and 58 % of MIS TLIF patients returning to full function (p > 0.05). Almost all patients have Grade 1 fusion (open: 98.5 %, MIS: 97.0 %, p > 0.05) with minimal new cage migration (open: 1.4 %, MIS: 0 %, p > 0.05).

Conclusions

MIS TLIF is a safe option for lumbar fusion, and when compared to open TLIF, has similar operative duration, good clinical and radiological outcomes, with additional significant benefits of less perioperative blood loss and pain, earlier rehabilitation, and a shorter hospitalization.     

探讨微创治疗肺大疱并气胸的疗效以及安全性

目的探讨微创治疗肺大疱并气胸的疗效以及安全性。方法回顾分析采用微创方法治疗的68例肺大疱并气胸患者的资料(观察组),并与腋下小切口手术的患者相对照(对照组),比较2组患者的临床疗效。结果观察组术中出血量和手术时间低于对照组,患者术后恢复良好,2组间的比较差异具有统计学意义(P<0.05)。此外,病患动脉氧分压(PO2)的比较差异具有统计学意义。结论两种治疗肺大疱并气胸的方法均有效,但微创治疗效果更佳,安全性更强。     

细菌性肝脓肿影响因素分析

目的探讨细菌性肝脓肿(pyogenic hepatic abscess,PHA)的患病风险。方法采用1∶1配对的病例对照研究,对31对病例及对照组相关9个危险因素进行条件Logistic回归分析。结果单因素分显示DM(OR=6.328,95%CI:1.787～22.409)、胆道疾病(OR=8.759,95%CI:1.006～76.097)和恶性肿瘤史(OR=4.444,95%CI:0.467～42.258)是PHA的可能风险因素(均P<0.20);多因素Logistic回归分析显示DM(OR=7.747,95%CI:1.975～28.275)是PHA的风险因素(P=0.003)。结论 DM患者患PHA的风险是非DM患者的7.75倍,提高对DM增加PHA患病风险的认识,早期诊治可能会改善预后。     

经会阴微创腹会阴联合切除术的临床实践

腹会阴联合切除术（APE）仍然是治疗低位直肠癌的标准手术方式。经肛提肌外APE可降低直肠癌环周切缘阳性率和肿瘤穿孔率,但术后并发症发生率较高。随着微创外科技术的不断发展,有研究者提出经会阴微创腹会阴联合切除术（Tpm-APE）。与传统APE比较,Tpm-APE具有潜在技术优势,然而目前缺乏大样本、多中心临床研究证据支持...