手术治疗75例阑尾周围脓肿

目的 探讨阑尾周围脓肿手术治疗的安全性及可行性.方法 回顾性分析75例阑尾周围脓肿患者施行Ⅰ期阑尾切除术资料.结果 75例手术均获得良好疗效.结论 阑尾周围脓肿早期手术治疗疗效肯定、安全.     

阑尾周围脓肿86例手术治疗体会

我们于1991年7月至2008年3月间收治急性阑尾周围脓肿病例共102例,其中Ⅰ期手术治疗86例(84.3%),收到了较好的疗效,现报告如下.     

阑尾周围脓肿Ⅰ期阑尾切除引流术150例报告

目的 :探讨阑尾周围脓肿Ⅰ期阑尾切除 +引流术的方法及评价。方法 :15 0例阑尾周围脓肿Ⅰ期阑尾切除引流术。其中大网膜包裹阑尾形成脓肿 115例 ,阑尾与肠系膜侧腹膜 ,肠壁间形成脓肿 3 5例。阑尾残端结扎荷包包埋 84例 ,残端无法包埋只能行周围腹膜覆盖残端者 19例 ,阑尾浆膜下切除根部肌层结扎浆膜缝合法 3 0例 ,根部腐烂不能结扎而行根部盲肠壁“8”字缝合 17例 ,全部脓腔放置腹腔双腔管引流 ,脓腔较大经引流管应用甲硝唑反复冲洗。结果 :15 0例全部治愈 ,伤口甲级愈合 14 4例 (96% ) ,切口感染 6例 (4 % ) ,术后无 1例发生肠瘘、粘连性肠梗阻、腹腔感染等并发症。平均 9天出院。结论 :阑尾周围脓肿Ⅰ期阑尾切除引流术是一种积极有效、安全的治疗方法 ,住院时间短 ,见效快 ,费用低 ,避免复发和阑尾周围炎症肿块以及脓肿引起并发症     

362病例阑尾周围脓肿的手术治疗体会

阑尾周围脓肿在基层医院很常见，对其治疗普遍认为以保守治疗为主，近二年来，作采用手术为第一措施治疗阑尾周围脓肿，取得了满意疗效，现就362例手术治疗情况报告如下。     

急诊手术治疗阑尾周围脓肿的体会

急诊手术治疗阑尾周围脓肿的体会徐恩胜，苏维新我院１９８６年６月至１９９２年１１月施行９２３例阑尾切除术，其中６２例系阑尾周围脓肿急诊手术，治疗效果满意，现报告如下：临床资料１．一般资料：阑尾周转脓肿急诊切除阑尾及引流脓计６２例，占同期阑尾切除术的６．...     

手术治疗老年阑尾周围脓肿临床体会

目的总结手术治疗老年阑尾周围脓肿的体会。方法对118例老年阑尾周围脓肿患者实施手术治疗,回顾性分析临床资料。结果本组118例均痊愈,其中78例行Ⅰ期手术,术后发生肠瘘1例,经对症处理愈合。40例行Ⅱ期手术治疗,随访1⁶个月,无其他并发症发生。结论对老年阑尾周围脓肿患者合理选择Ⅰ期或Ⅱ期手术,规范术中操作及术后处理,可明显减少并发症,提高治愈率。     

阑尾周围脓肿的即期手术治疗

阑尾周围脓肿是急性阑尾炎的一种类型 ,其发生率约占急性阑尾炎的 5 %～ 10 %。我院 1998年 8月～ 2 0 0 0年 8月对 5 0例阑尾周围脓肿行Ⅰ期阑尾切除 ,疗效满意 ,报告如下 :临床资料一、一般资料本组 5 0例中男 30例 ,女 2 0例。年龄 17～ 6 7岁 ,发病至手术时间最短 3ｄ ,最长 11ｄ。本组均有急性阑尾炎病史和体征症状。 2 5例可触及右下腹压痛性包块。术前 2 8例行腹部Ｂ型超声检查证实阑尾周围脓肿。白细胞计数 (11～ 2 2 )× 10 9/Ｌ ,Ｎ0 .83～ 0 .97。治疗 :均行阑尾切除术。结果 :术后 3例切口感染 ,1例出现假性肠梗阻 ,经保守治愈…     

手术治疗阑尾周围脓肿36例体会

阑尾周围脓肿是临床常见病。但以往对其治疗多采用保守疗法,效果欠佳。我院近2年来对所收治的36例阑尾周围脓肿病人采取手术治疗,疗效满意,现报告如下。临床资料1.一般资料:本组共36例,其中,男性21例,女性15例;年龄8~65岁,平均年龄35.6岁。发病至就诊时间在5~7d者11例,7~14d者2     

阑尾周围脓肿一期切除手术指征的探讨

阑尾周围脓肿是临床常见急腹症 ,其手术指征各有见解。传统观念认为 ,阑尾炎并发周围脓肿经药物保守治疗 3个月后 ,择期手术切除 ,效果较好。否则 ,将会带来术后并发症或严重后果。我们对 141例阑尾周围脓肿行急诊一期切除术 ,取得满意效果 ,现报告如下。临床资料一、一般资料 :我院外科自 1990年 1月～ 2 0 0 0年 12月 ,收治阑尾周围脓肿 141例 ,经临床诊断、B超及手术证实 ,排除美克尔氏憩室及肿瘤等疾病。研究组 86例 ,男 5 2例 ,女 34例 ,年龄 6～ 73岁。经常规术前准备 ,术前 2 h静脉推注或滴注抗生素 (氨苄或先锋类 ) ,急诊或限期 2 …     

手术治疗阑尾周围脓肿350例临床分析

目的探讨阑尾周围脓肿的手术方法及效果。方法选取郸城县人民医院2005-01—2016-01间手术治疗的350例阑尾周围脓肿患者,行常规阑尾切除术284例、浆肌层下阑尾黏膜切除术48例、脓肿引流术18例。对患者的临床资料进行回顾性分析。结果术后切口感染21例(6%),其中阑尾切除术12例、脓肿引流术9例。并发盆腔脓肿3例(0.86%),均为脓肿引流术。均经对症处理后痊愈。无1例发生肠瘘,全部治愈出院。术后随访1~3 a,无1例阑尾炎再次发作。28例(8.00%)并发粘连性肠梗阻(共计2~3次),其中阑尾切除术22例、脓肿引流术6例,均经非手术方法缓解。结论阑尾周围脓肿是急性阑尾炎常见的病理类型,合理选择手术方式,规范术中操作及术后处理,可明显缩短疗程、减少并发症发生率、提高治愈率。     

腹腔镜手术治疗婴幼儿阑尾脓肿

目的:探讨腹腔镜手术治疗婴幼儿阑尾脓肿的可行性,以及与既往治疗方案相比的优势。方法:回顾分析2011年1月至2011年7月为45例阑尾脓肿患儿行腹腔镜手术的临床资料;患儿7个月～5岁,出现症状至就诊时间为3～10 d,腹部超声均提示阑尾周围脓肿。37例患儿入院后即行急诊手术,余8例患儿入院后保守治疗12～24 h无效后行腹腔镜手术。均采用3孔法(5 mm Trocar),脐部置入腹腔镜,左下腹及耻骨上切口为操作孔,阑尾及系膜均用丝线结扎。如阑尾粗大,耻骨上Trocar更换为10 mm后取出阑尾,必要时经耻骨上切口放置腹腔引流管。术后予以三代头孢联合甲硝唑抗炎,禁食2～3 d,腹腔引流管于术后2～4 d拔除。将同组手术人员完成的40例开腹婴幼儿阑尾脓肿手术及28例阑尾脓肿经抗炎保守治疗好转后择期行腹腔镜阑尾切除术的婴幼儿作为对照,对比患儿围手术期及术后并发症情况。结果:45例手术均获成功,手术时间35～130 min,平均75 min。与开腹手术相比,手术时间两组无显著差异(P>0.05);并发症方面腹腔镜组较开腹组低,差异有统计学意义(P<0.05)。此外,择期腹腔镜组手术时间较腹腔镜组短,但术后并发症发生率差异无统计学意义(P>0.05),而总体住院时间明显延长,两组差异有统计学意义(P<0.05)。结论:只要手术及围手术期处理得当,腹腔镜手术治疗婴幼儿阑尾脓肿是安全可行的。腹腔镜手术在寻找阑尾、处理脓肿及腹腔局部冲洗等方面具有明显优势,因此术后切口感染率、腹腔残余感染率及粘连性肠梗阻发生率均较开腹手术低,从而减少了抗生素的使用时间,利于术后康复。     

Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients

Background

The risk factors for recurrent appendicitis in pediatric patients are unclear. This study aimed to identify the predictive factors for recurrent appendicitis in pediatric patients who initially underwent successful non-operative management of uncomplicated appendicitis.

Methods

Potential predictive factors for recurrent appendicitis in terms of clinical characteristics, laboratory data, and abdominal ultrasonography and computed tomography findings, were evaluated.

Results

This study included 125 patients who underwent initial successful non-operative management of appendicitis. The rate of recurrent appendicitis was 19.2%, and the mean time to recurrence was 12.6 months. Univariate analyses found that rebound tenderness, muscle guarding, appendicoliths, appendiceal diameter > 9 mm, and intraluminal appendiceal fluid were associated with recurrent appendicitis.Multivariate analysis identified only intraluminal appendiceal fluid as an independent predictor of recurrent appendicitis.

Conclusions

Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial non-operative management. The results of this study provide valuable information that may help to determine the appropriate management during the first episode of appendicitis.     

Treatment of appendiceal abscess

Appendiceal abscess occurring in 193 patients during a 14-year period is reviewed. Treatment was nonsurgical in 98 patients, with a complication rate of 3%. In the 95 surgically treated patients the complication rate was 32%. One patient died. 'Interval' elective appendectomy was performed in 80 cases and the complication rate was 23%. Among the 32 patients without surgery or in whom the appendix was not removed at laparotomy, the recurrence rate was 3%. No malignancy was found at colonic radiography in 84 conservatively treated patients. Based on these findings, the following strategy is recommended for management of appendiceal abscess. 1) Initially conservative treatment, with surgical intervention if this fails. 2) 'Interval' elective appendectomy not routinely undertaken. 3) For patients older than 40, follow-up with colonic radiography, possibly colonoscopy and, if necessary, also exploratory laparotomy to exclude intraabdominal malignancy.     

A case of primary psoas abscess presenting as buttock abscess

Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3 weeks. After 6 months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.     

Ultraconservative management of appendiceal abscess

An appendiceal abscess is usually treated conservatively. Drainage of the abscess is instituted if this treatment is unsuccessful. Some surgeons practise immediate appendectomy and abscess drainage. An alternative ultraconservative approach whereby abscess drainage is avoided has been reviewed retrospectively. Twenty-eight patients were treated by observation only. They remained in hospital for between 1 and 36 days (median 10 days) until their signs and symptoms disappeared. No patient required surgery or developed complications in hospital. One patient developed acute appendicitis 10 days after discharge. One developed a recurrent abscess. Another group of 19 patients were treated over the same period of time by immediate operation. Ten developed postoperative complications. Hospitalization ranged from 4 to 36 days (median 8 days). Ultraconservative management of appendiceal abscess is a safe and effective alternative to immediate surgery, or ultrasound- or computed tomographic-guided drainage.     

Liver abscess as the initial manifestation of colonic Crohn's disease: Report of a case

Liver abscess is a rare complication of Crohn's disease and in most of the reported cases, the diagnosis of Crohn's disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohn's disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohn's disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohn's disease should be included in the differential diagnosis of diseases causing liver abscess.     

Psoas abscess in children

In children, psoas abscess does not head the list in the differential diagnosis of the child who presents with a limp or lower abdominal pain. Therefore, the road to this diagnosis can be long and complicated leading to numerous studies and specialty consultations. Over a 7-year period, seven psoas abscesses have been drained surgically. All were Staphylococcal though one was mixed. In each case, the original admitting diagnosis was that of septic arthritis of the hip. In general, this diagnosis was ruled out by negative hip aspirations and bone scans. Often, the severity of symptoms led to persistent evaluation with noninvasive tests such as gallium scan, intravenous pyelogram, or barium enema. Though these tests were often suggestive, a positive ultrasound or CT scan was the key studies diagnostic enough to warrant surgical exploration and drainage. During this time period, there have been no negative explorations for psoas abscess. Upon surgical drainage, all patients improved, with subsequent recovery of hip function. The child who presents with a limp or painful hip should be considered for ultrasonography or computerized tomography once hip pathology is ruled out. We feel that the results of other tests such as gallium scan, IVP, or barium enema are not sufficiently specific to indicate surgery.     

垂体脓肿的诊断与治疗(附10例报告)

目的探讨垂体脓肿的临床特点、诊断和治疗。方法回顾性分析10例垂体脓肿的病史、临床表现、影像学表现、手术记录和随访结果。结果8例早期出现尿崩症,影像学表现为MRI检查T1像等信号或低信号,T2像等信号或高信号,环行强化,5例垂体柄增粗50%,随访6个月至4年,均未见复发。结论早期尿崩症、垂体柄增粗和环形强化的囊性病灶应首先怀疑垂体脓肿,早期诊断、及时手术和合理的抗生素治疗是提高垂体脓肿预后的关键。