阑尾周围脓肿个体化治疗体会

目的总结阑尾周围脓肿个体化治疗的临床经验。方法选择56例阑尾周围脓肿患者,年龄16~77岁,平均(44±10.6)岁,分别采取脓肿引流术,阑尾切除术加脓腔引流术和中西医结合非手术治疗3种方法。结果 16例脓肿引流术病人切口Ⅰ期愈合;24例阑尾切除加脓腔引流病人除2例切口感染Ⅱ期愈合外,余均Ⅰ期愈合,无1例肠瘘及腹腔脓肿发生;16例非手术治疗患者,治疗顺利无中转手术。结论对阑尾周围脓肿的治疗应根据患者病情设计个体化治疗方案,可取得良好效果。     

Roux—Y手术治疗严重十二指肠损伤：（附5例报告）

近5年来,我们对5例严重闭合性十二指肠损伤(指十二指肠破裂在肠管周径50％以上,或断裂伤包括合并胰头损伤但无主胰管损伤)采用Roux-Y手术治疗,仅1例并发腹腔脓肿和切口感染,均治愈。临床资料一般资料:5例均为男性,年龄为18～24岁。从外伤至手术时间最短为5小时,最长为27小时。除1例并发腹腔脓肿和切口感染经抗生素引流治愈外,无其     

急诊处理阑尾周围脓肿合并腹膜炎21例临床体会

目的研究急诊处理阑尾周围脓肿合并局限性或弥漫性腹膜炎的临床疗效。方法回顾性分析2012年4月至2016年4月在我院行急诊手术处理的阑尾周围脓肿合并腹膜炎患者21例,对其进行急诊阑尾切除术以及腹腔引流。结果术后联合抗生素对进行抗感染治疗,切口均一期愈合,无肠瘘、肠梗阻等并发症发生。引流管留置时间为3~5 d,平均引流时间为(3.76±0.83)d,其术后住院天数为6~11d,平均住院天数为(7.67±1.28)d。手术后,患者的疼痛视觉模拟评分(visual analogue scale,VAS)由(5.27±0.68)分下降到了(3.06±0.43)分,手术前后比较差异显著(P0.05)。结论对于阑尾周围脓肿合并腹膜炎的患者,早期进行急诊阑尾切除手术与脓肿引流是一种积极可靠的方法,且具有较好的疗效。     

阑尾周围脓肿Ⅰ期行阑尾切除腹腔引流手术(附110例报告)

我院 2 0 0 0年以来收治急性阑尾炎病人 3 2 1例中 ,阑尾周围脓肿急诊I期行阑尾切除腹腔引流手术治疗的有 110例 ,手术效果满意。现分析报告如下。临床资料1.一般资料 :本组 110例中 ,男 87例 ,女 2 3例 ;年龄 2～ 69岁 ,平均 3 7.8岁。发病至入院时间 3d 2 3例 ;3～ 7d 5 6例     

胆源性肝脓肿48例分析

胆源性肝脓肿是急性胆道感染的严重并发症,死亡率很高,深化胆源性肝脓肿的认识,必有助于本病和急性胆道感染的诊断和治疗。为此,特将作者体会并结合我院20年(1967～1986)来48例的病情分析报告如下。发病情况同期我院收治急性化脓性胆管炎患者839例,并发肝脓肿45例(占5.36%),急性胆囊炎302例,并发肝脓肿3例(占0.99%)。48例中男性22例,女性26例。年龄14～69岁,平均41.79岁。既往无胆道病史18例,有胆道病史14例,有胆道手术史16例(其中接受1次手术10例,2次4例,3次2例)。手术类型有胆总管T管引流9例,肝左外叶切除及T管引流1例.胆总管十二指肠或空肠吻合6例。     

儿童阑尾炎诊断和治疗12年经验总结

目的　总结儿童阑尾炎临床诊断与治疗12年来的进展。方法　回顾性分析1991年1月至2 0 0 2年12月收治的2 390例儿童阑尾炎的临床病理资料。结果　本组中单纯型2 37例(9 .91% ) ;化脓型1798例(75 .2 3% ) ,合并穿孔5 6 8例(31.5 9% ) ;坏疽型2 12例(8 .81% ) ,合并穿孔15 9例(71 .36 % ) ;梗阻型14 1例(5 .89% ) ;阑尾脓肿192例(7 .4 % ) ,其中手术切除阑尾加脓肿引流2 0例(0. 83% )。本组平均穿孔率为30 . 12 % ,1岁以下17例(41 .4 6 % ) ,1～4岁2 0 1例(44 .96 % ) ,5～10岁4 0 4例(2 8. 17% ) ,10岁以上98例(2 0. 94 % )。本组患者全部治愈出院。结论　单纯型阑尾炎手术比例数与穿孔率呈反比关系,反映手术指征宽严度与诊疗水平的情况。儿童阑尾炎的穿孔率在30 %左右是可以接受的。     

挂线引流结合手术切除治疗头部脓肿性穿掘性毛囊周围炎的临床效果

目的:探讨头部脓肿性穿掘性毛囊周围炎的手术治疗方式。方法:2015年6月至2018年10月,山东省栖霞市中医院皮肤科收治头部脓肿性穿掘性毛囊炎患者8例,年龄13～26岁,平均23岁。病程0.5～5年,脓腔直径0.5～4.0 cm。手术完整切除病变毛囊及炎症浸润的周围组织,深达脂肪层。窦道两端,脓腔两侧,放入橡皮引流条,...     

腹腔内炎性肌纤维母细胞瘤5例分析并文献复习

【摘要】〓目的〓探讨腹腔内炎症性肌纤维母细胞瘤(IMT)的临床特点、病理学特征、治疗方案及预后因素。方法〓对我院2008年6月至2013年5月诊治的5例腹腔炎症性肌纤维母细胞瘤患者的临床特点、病理形态、免疫组化及治疗方案进行分析并随访。结果〓男性2例,女性3例,年龄31~74岁,平均年龄53.4岁。主要症状为腹部包块。5例均行手术切除后病理检查确诊。随访时间6月~5年,其中1例局部复发。肿瘤3例来源于大网膜,2例来源于肠系膜。免疫组化Actin、Vimentin、SMA多呈阳性,S-100、CD117、CD34呈阴性。结论〓炎症性肌纤维母细胞瘤发病机制尚不明确,症状往往随着病变的切除而消失,手术切除是主要治疗方法。但其又具有一定的恶性倾向,部分患者术后复发,所以需要密切随访。     

首次引流失败对肝门部胆管癌患者术后预后的影响

目的探讨首次引流失败对肝门部胆管癌(PHCC)患者术后预后的影响。方法回顾性分析2014年4月至2022年12月南京大学医学院附属鼓楼医院胰腺与代谢外科收治的行手术切除的68例PHCC患者的临床资料, 其中男性46例, 女性22例, 年龄(63±9)岁, 年龄范围39～80岁。依据首次引流是否成功分为两组:成功组(n=34)和失败组(n=34)。记录患者的年龄、性别、首次引流情况、并发症等临床资料。采用门诊及电话方式随访, 记录患者的生存情况。采用Kaplan-Meier法进行生存分析, 生存率比较采用log-rank检验。结果与成功组相比, 失败组PHCC患者的引流时间[41(28, 52)d比20(14, 28)d]、引流管调整率[32.4%(11/34)比0(0/34)]、引流后并发症发生率[88.2%(30/34)比0(0/34)]均增加, 引流部位正确率[82.4%(28/34)比100%(34/34)]降低, 差异均有统计学意义(均P<0.05)。与成功组比较, 失败组腹腔感染发生率较高[70.6%(24/34)比44.1%(15/34)], 差异有统计学意义(P=0...     

老年胃癌患者的手术治疗

表1128例老年胃癌患者合并疾病情况1995年5月至2004年2月我院共收治70岁以上老年胃癌患者128例,现将我们手术治疗的经验总结分析如下。临床资料128例患者中男73例、女55例,年龄70～91(平均73.3)岁。术前合并疾病见表1。本组病例均行上消化道钡餐检查及胃镜病理活检确诊。行根治性胃大部切除57例(44.5%);全胃切除13例(10.2%);根治性联合脏器切除5例(3.9%);姑息性切除32例(25.0%);捷径手术9例(7.0%);剖腹探查、胃空肠造瘘术12例(9.4%)。术后选择肠外营养34例(26.6%),肠内营养94例(73.4%)。全组有107例行切除性手术,手术切除率83.6%。术后并发…     

Surgical versus percutaneous drainage of intra-abdominal abscesses

The records of 83 patients with intra-abdominal abscesses treated between 1986 and 1990 were reviewed to determine if there were significant differences in the outcome of patients treated by surgical drainage (n = 41) or percutaneous drainage (n = 42). The two groups were matched for age, abscess location, and etiology. Parametric statistical evaluations included the Student's t test as well as analysis of variance; nonparametric statistics used were chi-square and Wilcoxon rank sums. No significant difference was found in mortality (surgical 14% versus percutaneous 12%) or morbidity (surgical 26% versus percutaneous 29%). The duration of hospital stay was similar. Although there was no significant difference between the two groups in severity of illness as measured by APACHE II scores, these scores were significant in determining prognosis. APACHE II scores were significantly higher in non-survivors of both groups (23 versus 13) and also higher in those developing complications. A subgroup of patients with diverticular abscess was identified in whom percutaneous drainage enabled later resection with primary anastomosis without complication. This study indicates that percutaneous drainage of an intra-abdominal abscess is as efficacious as surgical drainage and that APACHE II scores are prognostic of both potential mortality and morbidity.     

Management of intra-abdominal abscesses in Crohn's disease.

Over a 5-year period, 54 intra-abdominal abscesses were observed in 40 (20.8%) of 192 patients with Crohn's disease. The median age was 39 years (range 17-76 years); median interval from diagnosis, 7.5 years (range 0-24 years) and the median number of surgical operations was 2 (range 0-7). Forty abscesses (74.1%) were spontaneous and 14 (25.9%) were postoperative. Thirty abscesses were initially managed by laparotomy, 14 by percutaneous drainage, nine by incision and drainage and in one case the abscess drained spontaneously. Intra-abdominal abscesses were managed successfully by laparotomy in 23 (76.7%) of 30 patients, with a 93% success rate (13 of 14) for spontaneous abscesses managed by resection and primary anastomosis. Three of 8 (37.5%) spontaneous abscesses were managed successfully by percutaneous drainage, a temporising effect being achieved in a further two cases. There was no significant difference in sepsis score or duration of hospital stay for patients managed initially by laparotomy and those managed by drainage. However, patients with stricturing or fistulating Crohn's disease were much more likely to have initial management by laparotomy and in these patients surgical intervention was found to be an effective initial strategy.     

Strategies in the management of pyogenic psoas abscesses.

The presentation and management of eight patients with pyogenic psoas abscesses treated at the National Naval Medical Center, Bethesda, Maryland, between January 1986 and July 1989 are presented. The psoas abscesses were secondary to underlying gastrointestinal disease in six patients and sacral osteomyelitis in one patient. In one patient, the etiology of the abscess could not be determined. The average duration of symptoms in these patients was 16 days. Computed tomography was useful in identifying the abscess, defining its complexity, and planning therapy in all eight patients. Seven patients had complex, multiloculated abscesses, and one patient had a simple abscess. Extraperitoneal drainage was used in all patients. The patients with multiloculated abscesses had open surgical drainage, while the patient with the simple abscess had percutaneous catheter drainage. Most patients with a gastrointestinal etiology for their abscess underwent staged resection 3 to 6 weeks after the drainage procedure. There were no deaths, recurrent abscesses, or fistulae in these patients. Two patients developed thromboembolic complications postoperatively. Extraperitoneal drainage with staged resection of underlying gastrointestinal pathology is a safe and effective way of treating patients with psoas abscesses.     

Acute surgical emergencies in inflammatory bowel disease

BACKGROUND: Acute surgical emergencies in patients with inflammatory bowel disease may carry a substantial morbidity, but fortunately today, a low mortality. The aim of this review is to delineate the treatment of acute surgical emergencies that occur in patients with ulcerative colitis and Crohn's disease. METHODS: Suitable English language reports were identified using PubMed search. RESULTS: Inflammatory bowel disease can present in numerous ways as an acute surgical emergency. These include toxic colitis, hemorrhage, perforation, intra-abdominal masses or abscesses with sepsis, and intestinal obstruction. Toxic colitis and perforation are best managed with intestinal resection and fecal diversion. Hemorrhage in ulcerative colitis initially requires colectomy with rectal preservation and ileostomy. In Crohn's disease hemorrhage is often focal and localization and segmental resection are performed. Intra-abdominal abscesses should initially be attempted by computed tomography-guided percutaneous drainage followed subsequently by definitive resection. Perianal disease requires abscess drainage with minimal tissue trauma. Intestinal obstruction should be initially managed nonoperatively, with surgery reserved for complete obstruction or intractability. CONCLUSIONS: Acute surgical emergencies in patients with inflammatory bowel disease are rare and can have a high morbidity. With a multidisciplinary approach, morbidity can be reduced and patients can have a rapid return and improved quality of life.     

Candida species. Insignificant contaminant or pathogenic species

The pathogenicity of Candida species cultured from peritoneal fluid or from an intra-abdominal abscess is unknown. A review of cultures at NCMH from 1978 to 1983 showed that Candida species were cultured from the peritoneal fluid of 39 patients and from intra-abdominal abscesses in 24 patients. The average age was 49 (range 6 months to 102 years); there were 38 men and 25 women. None of the 39 patients with Candida species grown from the peritoneal fluid was treated with Amphotericin B and only 1 (2.6%) subsequently developed an abscess. This patient was treated by surgical drainage without Amphotericin B and recovered. Twenty-four patients had Candida cultured from an intra-abdominal abscess. Of these, 21 (87.5%) also grew other bacterial organisms. Twenty of these 24 patients were treated with surgical drainage and antibacterial antibiotics without Amphotericin B. Six (30%) died, but only one death was felt to be directly related to the Candida infection. The remaining four were treated with surgical drainage, appropriate antibacterial antibiotics, and Amphotericin B. Two of these four (50%) died; one of the two deaths was related to Candida infection. Candida species grown from the peritoneum were not related to later Candida infection. Treatment of patients with contamination of the peritoneum by Candida with Amphotericin B appears unnecessary and because of Amphotericin renal toxicity, may be potentially harmful. Patients with polymicrobial intra-abdominal abscesses that contain Candida species should be treated with surgical drainage and appropriate antibacterial antibiotics. The value of adding Amphotericin B therapy in patients with polymicrobial abscess containing Candida was not demonstrated in this study, and its role is unclear.     

Diverticulitis,pelvic and other intra-abdominal abscesses

Diverticular disease is a common condition in the Western world and it carries significant morbidity and healthcare cost. Patients with diverticular disease may present acutely or to out-patients, and the management should be stratified using clinical judgement and appropriate investigation including radiology. Intra-abdominal abscess is a common complication of diverticular disease, but it can also be due to any intra-abdominal organ disease. Conservative management is safe but in the “unwell” patient, other options such as: radiological drainage, laparoscopic washout and drainage, and surgical resection can be life-saving. Careful selection of patients using current stratification tools will help with management. All patients with intra-abdominal abscesses require follow-up and possibly further investigations. This article discusses current evidence and controversies underlying today's management of diverticulitis, diverticular abscess and other intra-abdominal abscesses.     

Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess

HYPOTHESIS: Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD). METHODS: We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome. RESULTS: The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. CONCLUSIONS: Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.     

Laparoscopic drainage of postoperative complicated intra-abdominal abscesses

Intra-abdominal abscess, which carries significant rates of death and complications, may complicate the postoperative course. Treatment options include percutaneous needle aspiration, placement of an external drain under ultrasonic guidance, or surgical drainage, depending on the size, site, and nature (simple or complicated) of the abscess. Laparoscopic drainage may be a treatment option. A retrospective review of patients who underwent laparoscopic drainage of postoperative complicated intra-abdominal abscesses at the authors' institution from January 1997 to July 1999 was performed. Seven patients had complicated intra-abdominal abscesses 7 to 17 (mean 11) days after their initial operation. All abscesses were successfully drained by laparoscopy. The mean operative time was 64 minutes. There were no intraoperative or postoperative complications. The postoperative analgesic requirement was minimal. The suction drain was removed on average 5 days after laparoscopy, and the mean hospital stay was 6 days. There was no recurrence of symptoms at a mean follow-up of 23 months. Laparoscopic drainage, in combination with systemic antibiotics, is a safe and effective treatment option in patients with postoperative complicated intra-abdominal abscesses.     

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.     

经腹腔穿刺器置双套管引流治疗腹腔脓肿

目的 探讨经腹腔穿刺器(Trocar)置双套管引流在腹腔脓肿治疗中的应用.方法 回顾性分析2010年6-12月间在南京军区南京总医院接受经腹腔穿刺器置双套管引流的32例腹腔脓肿患者的临床资料.操作方法:超声与CT明确脓肿部位及大小后,在CT或超声下定位并明确穿刺深度,经腹腔穿刺器穿刺置双套管引流.结果 32例患者均成功穿刺,1例因胰腺癌术后出现肝转移合并多脏器功能衰竭死亡,1例因多发小肠瘘感染灶未局限需开腹手术引流;其余30例患者引流后感染症状逐渐缓解,并最终治愈,平均愈合时间为(7±3)d.2例合并穿刺处皮下出血,经局部压迫止血,出血停止.结论 经Trocar穿刺置入双套管引流治疗腹腔脓肿疗效满意,尤其适用于脓液黏稠或存在蜂窝织炎及坏死组织、脓肿呈多囊性且脓腔较大者.

Abstract：

Objective To study the effects of placement of double cannula using trocar puncture for intra-abdominal abscess drainage. Methods A retrospective study was performed to investigate the clinical data of 32 patients undergoing intra-abdominal abscess drainage with double cannula placed using trocar puncture between June 2010 and December 2010. Techniques: the location and size of the abscess was evaluated by ultrasound and CT. Placement of double cannula using trocar puncture was performed under CT or ultrasound guidance. Results Trocar puncture was successful in all the patients . One patient died of liver metastasis and multiple organ failure after surgery for pancreatic cancer. One patient required laparotomy and drainage because non-localization of sepsis from intestinal fistula. The remaining 30 patients experienced alleviation of septic symptoms after drainage and eventually cured. The mean healing time was (7±3) days. Two patients developed subcutaneous bleeding and were management by local compression. Conclusions Placement of double cannula using trocar puncture for intra-abdominal abscess drainage results in satisfactory outcomes. This technique is especially suitable for abscesses with viscous drainage, those with the presence of phlegmon or necrotic debris, and those with multiple large cavities.