细菌性肝脓肿的放射介入治疗

目的：探讨放射介入治疗（或联合经皮肝脓肿穿刺引流）治疗细菌性肝脓肿的效果。方法：回顾性分析65例细菌性肝脓肿病人（其中2例行介入治疗）的临床资料。结果：介入组无1例需中转手术引流，均痊愈出院；对照组39例中有2例因脓肿导管引流不畅需行手术引流，3例死于多脏器功能衰竭，病死率（7．7％）高于介入组，但差异无显著性（P＞0．05）；介入组病人的退热时间和脓肿消退时间均显著短于对照组（均P＜0．05）。结论：介入治疗细菌性肝脓肿的效果优于传统治疗方法。     

改良双腔气囊管引流治疗肝脓肿

肝脓肿是外科常见的感染性疾病,手术引流是治疗肝脓肿的基本方法之一。我院自1990年6月以来应用改良双腔气囊管治疗肝脓肿,效果满意,现报告如下。临床资料1.一般资料:116例肝脓肿患者随机分为A、B两组。A组(应用双腔气囊管引流组)65例,男46例,女19例,年龄为8~72岁;细菌性55例,阿米巴性3例,混合性6例,晚期肝癌伴感染1例;脓腔大小4~15.5 cm;脓肿位于肝左叶者21例,肝右叶者32例,两叶均有者12例;病程1~164 d。B组(对照组)51例,为普通橡皮管作引流者,其中男39例,女12例;细菌性45例,阿米巴性2例,混合性4例;脓腔大小3.5~14.5 cm;脓肿位于肝左叶者…     

肝脓肿103例临床分析

目的: 总结肝脓肿的治疗经验. 方法: 回顾分析103例肝脓肿病人的临床资料. 结果: 41例肝脓肿行手术脓肿引流.15例行肝部分切除.47例采用放射介入区域性动脉灌注抗生素,其中4例加做B超引导下经皮肝脓肿穿刺置管引流.全组2例死亡,其中1例因肝脓肿渍破致腹膜炎、中毒性休克并发MOF死亡. 结论: 巨大单发脓肿宜手术引流,采用U型管引流;肝部分切除是治疗胆源性肝脓肿的重要手段;放射介入区域性动脉灌注抗生素治疗多发性肝脓肿及小于8 cm的单个脓肿疗效良好,对于大于8cm巨大单发脓肿宜加做B超引导下经皮肝脓肿穿刺置管引流术.     

肝动脉栓塞化疗联合经皮射频消融治疗肝癌

目的: 探讨肝动脉栓塞化疗联合经皮射频消融治疗不能手术切除的肝癌的价值.方法: 对2000年2月至2003年2月间103例不能手术切除的肝癌分别行肝动脉栓塞化疗(51例)或肝动脉栓塞化疗联合经皮射频消融(52例).结果: 两组治疗后6个月生存率差异无显著性意义(P>0.05),1年及2年生存率差异有显著性意义(P<0.01).肿瘤缩小率差异有显著性意义(P<0.01).结论: 对不能手术切除的肝癌,肝动脉栓塞化疗联合经皮射频消融能明显提高肿瘤缩小率及生存率.     

细菌性肝脓肿经皮肝穿刺与手术治疗疗效对比

比较经皮肝穿刺与手术治疗细菌性肝脓肿的疗效。病例和方法:1990年1月至1996年3月的6年中,瑞金医院外科收治了38例细菌性肝脓肿病人。其中22例作经皮肝穿刺引流,16例经腹手术引流。两组病人年龄、病灶大小及部位,病情程度等无明显差异。对两种治疗方法作疗效比较。结果和结论:经皮肝穿刺引流成功的病人在饮食、血象、体温恢复正常时间以及抗生素应用时间,住院天数等方面明显优于经腹手术引流组,此外在输血量及住院总费用上,穿刺组也明显少于手术引流组。穿刺引流方法简便、安全、成功率高、并发症少、经济实用。     

细菌性肝脓肿外科处理的临床分析

目的总结细菌性肝脓肿的诊治经验。方法对我院从1992年-2002年十年间所收治的105例细菌性肝脓肿病人进行回顾性分析。本组治疗方法包括：单纯抗生素治疗21例,外科手术引流30例,腹腔镜手术引流6例,经皮穿刺抽吸治疗42例,经皮穿刺置管引流治疗6例。结果本组治愈101例,死亡4例,死亡率3．8％。结论早期诊断和恰当的治疗是提高细菌性肝脓肿疗效的重要因素,超声引导下穿刺抽吸和／或置管引流已成为细菌性肝脓肿的治疗首选,适合于大部分病人。而外科手术引流仅适合于介入治疗失败或脓肿破裂病人。     

改良双腔气囊管引流治疗肝脓肿的临床应用

目的改善肝脓肿切开引流术的引流效果。方法116例肝脓肿病人随机分为A、B两组,A组应用改良双腔气囊管引流,B组采用常规橡皮管引流,对比分析两组病人的引流效果。结果A、B两组治愈率无显著差异(P>0.05),术后体温、血象恢复正常时间及住院天数有显著性差异(P<0.01)。结论改良双腔气囊管的应用可以显著改善肝脓肿手术引流的效果。     

细菌性肝脓肿经皮肝穿刺与手术治疗疗效对比

目的：比较经皮肝穿刺与手术治疗细菌性肝脓肿的疗效。病例和方法：１９９０年１月至１９９６年３月的６年中，瑞金医院外科收治了３８例细菌性肝脓肿病人，其中２２例作经皮肝穿刺引流，１６列经腹手术引流。两组病人年龄、病灶大小及部位、病情程度等无明显差异，对两种治疗方法作了疗效观察。结果和结论：经皮肝穿刺引流成功的病人在饮食、血象、体温恢复正常时间以及抗生素应用时间、住院等方面明显优于经腹手术引流组，此外在输     

21例颈椎前路手术的加速康复外科理念应用体会

目的 探索加速康复围手术期管理方法在颈椎前路手术中的作用。方法 回顾分析2019年7月至2021年6月我科收治的42例颈椎病患者,其中加速康复组和传统组各21例,比较两组患者围手术期资料（手术时间、出血量、引流放置时间、离床活动时间、术后住院时间）、临床疗效、吞咽功能。结果 两组基线资料差异无明显统计学意义（P>0.05）。在围手术期资料方面,加速康复组手术时间、术中出血量与传统组无明显差异（P>0.05）,而引流管放置时间、术后离床活动时间、术后住院时间均较传统组短（P<0.05）。在临床疗效方面,两组术后1天、1月、6月VAS评分及术后1月、6月JOA评分均较术前明显改善（P<0.05）,加速康复组术后1天VAS评分优于传统组（P<0.05）,其余时点及VAS评分、JOA评分两组间无明显统计学差异（P>0.05）。在吞咽功能评分方面,加速康复组在术后1天、术后1月轻度及以下吞咽困难比例较传统组高,中度吞咽困难患者比例较低（P<0.05）,而术后6月两组吞咽困难评分差异无明显统计学意义（P>0.05）。在术后并发症方面,加速康复组出现1例皮肤浅层感染,2例尿潴留,传统组出现1例肺部感染,经过保守治疗后好转,无再次手术患者,无其他重大并发症。结论 加速康复理念运用于颈椎前路手术中,可改善围手术期疗效,缩短住院时间,有利于提高患者手术体验。     

改成熟型肝脓肿引流术为清除术的25例报告

目的:探讨以肝脓肿清除术取代传统肝脓肿引流术的可能性和方法。方法:对25例细菌性肝脓肿病人进行回顾性分析;22例采用冲洗、烧灼、加网膜填塞的方法(即“冲、烧、填”法),对另3例肝慢性坚壁脓肿(其中1例合并经久不愈的窦道)施行肝切除,从而达到完全清除脓肿组织的目的。结果:22例冲、烧、填法治疗的病人手术一次成功,不置引流物;术后7～9d出院,无一例切口感染;随访1～12年,无任何后遗症。3例肝切除者也获满意疗效。结论:肝脓肿清除术与传统引流术相比,具有治疗全过程时间短、费用低、疗效好及并发症少的优点,值得推广应用。     

Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage

A retrospective review of 39 patients with pyogenic hepatic abscess treated from 1977 through 1984 included 23 patients who were surgically treated and 16 who underwent percutaneous drainage. The average age in each group was similar (about 55 years). The most common cause of abscesses in each group was biliary tract disease. Abscesses caused by portal seeding and local extension were more common in the surgical group, 14 of whom required additional surgical procedures at the time of surgical drainage. Of the 16 patients in the percutaneously drained group, seven were seen during the immediate postoperative period. Most of the abscesses occurred in the right lobe of the liver, but single abscesses in the left lobe (30%) and multiple abscesses (57%) were more common in the surgical group. Klebsiella enterobacter and group D streptococcus were most common in the surgically and percutaneously drained groups, respectively. All patients received antibiotics, with a mean length of treatment of 14 days. Mean time to defervescence was about four days in both groups, with a longer hospital stay for the percutaneously drained group (26 vs 46 days). Morbidity was high in both groups (surgical, 48%; percutaneous, 69%). Three of the percutaneously treated patients required surgical drainage because of highly viscous abscess contents. Mortality was 17% in the surgical group and 13% in the percutaneously drained group. Percutaneous drainage with computed tomography probably should be the initial drainage procedure in patients with pyogenic hepatic abscesses in whom no concomitant surgical procedure is planned. Regardless of treatment, the morbidity and mortality remain high.     

Pyogenic liver abscess: Changing patterns in approach

AIM: To define optimum management of the pyogenic liver abscess and assess new trends in treatment.METHODS: One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir (India) from July 2001 to August 2006 were studied to evaluate and define the optimum treatment.RESULTS: Mortality in the surgically treated group of patients was 9.4% (12/119), while those treated non-surgically had a fatality rate of 16.66% (7/42). Multiple liver abscesses treated surgically had a surprisingly low mortality of 30%. The biliary tract (64.97%) was the most common cause of liver abscess. Multiple abscesses, mixed organisms and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor in determining survival.CONCLUSION: Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.     

Renal and Perinephric Abscesses: Analysis of 65 Consecutive Cases

Objective The objective was to describe the last 10 years’ experience of the diagnosis and treatment of renal, perinephric, and mixed abscesses in an academic reference center. Patients and Methods The medical records of 65 patients with renal, perinephric, and mixed abscesses treated at our hospital from January 1992 to December 2002 were reviewed. The data collected included predisposing factors, symptoms, physical examination, initial diagnosis, laboratory and radiologic evaluation, treatment, and clinical outcome. Results Perinephric abscesses were found in 33 (50.8%) patients, renal abscesses were found in 16 (24.6%), and 16 (24.6%) had mixed abscesses. Urolithiasis (28%) and diabetes mellitus (28%) were the most common predisposing conditions. The duration of symptoms before hospital admission ranged from 2 to 180 days (mean 20 days). Urine culture was positive in 43% of patients and blood culture was positive in 40% of patients. Most of the perinephric abscesses received an interventional treatment: surgical drainage (24%), percutaneous drainage (42%) or nephrectomy (24%). Most patients were cured (73.3%) on discharge from hospital. Mixed (renal and perinephric) abscess treatment was similar: percutaneous drainage (37.5%), surgical drainage (18.75%) or nephrectomy (37.5%). Most patients were cured (60%) on discharge from hospital. Renal abscesses, however, were treated medically in 69% of patients and 73% were cured on discharge from hospital. Conclusions Perinephric and mixed abscesses are successfully managed by interventional treatment. Renal abscesses can be managed by medical treatment only, reserving interventional treatment for large collections or patients with clinical impairment. Early diagnosis is an important factor in the outcome of renal and perinephric abscesses.     

Pyogenic liver abscess complicated by endogenous endophthalmitis

Background: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. Methods: Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. Results: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. Conclusion: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.     

双靶区序贯调强放疗联合介入治疗巨块型肝癌的临床研究

目的:探讨双靶区序贯调强放疗联合介入治疗巨块型肝癌的疗效。方法:选择2008年1月—2015年1月符合研究要求的巨块型肝癌共81例,随机分为观察组和对照组,观察组40例选用2次介入+双靶区序贯调强放疗(30~40 Gy/15~20 F)、对照组41例行2次介入+超分割交替调强放疗(30~40 Gy/15~20 F),比较两组患者的疗效和不良反应。结果:术后两组AFP水平均较术前明显降低;观察组与对照组总有效率为86.8%与79.5%;观察组与对照组中位生存期分别为10.3、9.7个月,6个月与1、2、3年生存率分别为63.2%和59.0%,50.0%和48.7%、21.1%和17.9%、5.3%和2.6%,以上指标两组间差异均无统计学意义(均P0.05)。观察组1~2度骨髓抑制发生率低于对照组(P0.05),但其他不良反应发生率两组间差异均无统计学意义(均P0.05)。结论:双靶区序贯调强放疗与超分割交替调强放疗联合介入治疗巨块型肝癌均有较好的临床疗效,且不良反应能耐受,两种方法均为巨块型肝癌的有效的治疗方式。     

Pyogenic hepatic abscess. Changing trends over 42 years.

OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14% vs. 26%). CONCLUSIONS: Significant changes have occurred in the etiology, diagnosis, bacteriology, treatment, and outcome patients with pyogenic hepatic abscesses over the past 4 decades. However, mortality remains high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results.     

细菌性肝脓肿经皮穿刺与手术治疗疗效的比较

目的：比较细菌性肝脓肿经皮穿刺与手术治疗的疗效。方法：回顾分析首都医科大学宣武医院1989年1月—2008年12月收治的193例细菌性肝脓肿患者的临床资料,按治疗方法分为经皮穿刺组（96例）及手术治疗组（97例）,比较2组的治疗成功率、并发症率、死亡率及住院时间。结果：2组患者的性别,年龄,糖尿病有无,白蛋白水平,脓肿的部位、个数、大小、来源等差异均无统计学意义。经皮穿刺组患者治疗成功率、死亡率及平均住院时间分别为87.5%（84/96）、2.1%（2/96）、（20.8±12.4）d;手术组为94.8%（92/97）、2.1%（2/97）、（18.9±13.5）d,差异均无统计学意义（P=0.072,1.000,0.575）。经皮穿刺组并发症率较手术组低（2.1%vs9.3%,P=0.037）。结论：经皮穿刺治疗细菌性肝脓肿与手术同样有效,且并发症率较低,应成为肝脓肿治疗的首选。     

合并肝酶升高的急性结石性胆囊炎行早期手术疗效分析

目的:探讨合并肝酶升高的急性结石性胆囊炎行早期手术的安全性和可行性。方法:回顾性分析2018年1月—2018年12月安徽理工大学第一附属医院普外科收治的39例合并肝酶升高的急性结石性胆囊炎患者的临床资料。其中男性14例,女性25例,年龄(57.59±15.30)岁,年龄范围29~84岁;所有患者均予以保肝和抗生素治疗,...     

肝癌根治性切除术后联合DC－CIK治疗的临床研究

目的探讨肝癌根治性切除术联合DC－CIK治疗对原发性肝癌患者的疗效。 方法自2011年6月至2014年6月对收治的原发性肝癌患者84例进行前瞻性研究,随机分为DC－CIK组和对照组,各36例。两组患者均给予肝癌切除术和肝动脉介入治疗,DC－CIK组在此基础上给予DC－CIK治疗。采用SPSS22.0进行统计分析,共随访3年,两组患者生活质量(QOL)、细胞因子和AFP等计量资料差异采用独立样本t检验分析;两组患者1～3年生存率(OS)、复发率和毒性反应等计数资料采用卡方检验分析;两组患者无疾病进展时间采用生存函数分析。P<0.05表示差异有统计学意义。 结果两组患者术后1～3年OS比较差异无统计学意义(P>0.05)。与对照组比较,DC－CIK组患者术后3年时复发率低于对照组(69.1%比47.6%, P＝0.046);无疾病进展时间显著延长[(48.9±2.9)比(38.9±3.4)月,P＝0.034]。两组患者术前AFP水平无统计学差异(P>0.05),术后12周时DC－CIK组患者AFP水平显著低于对照组。与对照组比较,DC－CIK组术后12周时CD4^＋T细胞、CD4^＋/CD8^＋、CD3^＋ CD56^＋NKT细胞显著增高(P<0.05)。两组患者治疗前后QOL评分、不良反应差异均无统计学意义(P>0.05)。 结论肝癌根治术切除联合DC－CIK治疗有助于提高免疫系统对肿瘤细胞的杀伤作用,改善生活质量、延长无疾病进展时间、降低术后复发率。