扁桃体周脓肿感染途径的探讨

为探讨扁桃体周脓肿的真正发病机理，感染途径，对连续诊治的１３１例扁周脓肿患者进行研究。其中８３例患侧的扁桃体被切除，切除之扁桃体外侧面均平整。通过８３例组织学观察，扁桃体上极表面既无扁桃溃破亦无脓瘘，邻接扁桃体上方之软腭粘膜下发现有感染及／或纤维化的小唾液腺，这些与扁桃体相邻的腺体在其他非扁周脓肿患者则显示正常形态与结构。从而认为扁桃体周围的化脓性感染可能与Ｗｅｂｅｒ腺有关，而非急性扁桃体炎，主张     

扁桃体周脓肿患者脓肿期手术切除扁桃体的临床观察

扁桃体周脓肿是扁桃体周围间隙内的化脓性炎症,早期发生蜂窝织炎,继之形成脓肿,是耳鼻咽喉科常见急症之一。对其保守治疗常有部分复发,目前主张手术治疗。本文回顾我科2002-2009年收治的120例扁桃体周脓肿患者,采用脓肿期手术、择期手术切除扁桃体,对其疗效分析如下。     

扁桃体周围脓肿期手术切除扁桃体的探讨

目的探讨扁桃体周围脓肿(peritonsillar abscess,PTA)手术切除扁桃体的最佳时机。方法回顾分析326例PTA患者,其中脓肿期手术组1 67例,择期手术组159例,对两种治疗方法进行比较。结果脓肿期手术组术中单侧平均出血量(10±2.3)ml、术后出血发生率3.0%、平均手术时间(10±1.2)分钟、平均住院日(8±1.1)天;择期手术组术中单侧平均出血量(21±2.1)ml、术后出血发生率6.9%、平均手术时间(20±1.5)分钟、平均住院日(16±1.3)天,两组比较差异有显著性(P<0.05)。两组术后感染、扁桃体残留和治愈率无显著性差异(P>0.05)。结论患者在一般情况好、排除手术禁忌、脓肿切开排脓3～4天内,手术切除扁桃体较择期手术具有明显优越性。     

扁桃体周炎和扁桃体周脓肿43例报告

扁桃体周炎和扁桃体周脓肿为腭扁桃体炎常见的并发症之一，临床上并不少见。现将我科近几年间记录较为完整的43例报告如下，并对处理中的几个问题进行讨论。1临床资料本组共43例，其中男28例，女15例；年龄17～74岁，其中21～40岁占83．72％（36例）。左侧19例，右侧24例。43例中有23例既往无明确的咽病史。全部病例系首次发病，其中31例穿刺有脓液抽出，诊断为扁桃体周脓肿；12例穿刺阴性，诊断为扁桃体周炎。31例扁桃体周脓肿中29例切开引流，2例穿刺抽脓。选用青霉素或红霉素加灭滴灵治疗，扁桃体周炎患者加用激素。其中20倒在治疗后经3…     

婴幼儿扁桃体周脓肿4例

例1男，40d。因发热、咳嗽5d，右颈部肿胀3d，呼吸困难1d，于1996年8月21日以“支气管肺炎、右颈部淋巴结炎？”收住内科。5d前患儿发热，体温38～39C，吃奶少，咳嗽轻，当地医院用青霉素治疗无好转，出现呼吸声粗大，时有鼾声。近3d右面部及颈部肿胀，呼吸困难，面色发青。住院     

双侧扁桃体周脓肿

扁桃体周脓肿为扁桃体周围间隙内的化脓性炎症,早期发生蜂窝组织炎,继之形成脓肿。本科收治1例双侧同时发病患者,报告如下。1临床资料患者女,29岁。以咽喉疼痛伴进食困难4天入院。4天前出现咽部疼痛,伴明显畏寒,发热,就诊于当地医院,予以抗感染治疗无效。咽部疼痛加重,向双耳部     

扁桃体周脓肿不同时期手术36例

扁桃体周脓肿是扁桃体周围隙内的化脓性炎症,早期发生蜂窝织炎,继之形成脓肿[1],是耳鼻咽喉科常见急症之一.对其保守治疗常有部分复发,目前主张手术治疗,而不同时期手术效果有差异.     

扁桃体周围脓肿超声诊断方法探讨

临床诊断扁桃体周围脓肿传统方法是根据穿刺抽脓确诊.为减轻患者痛苦,我们用B超诊断扁桃体周围脓肿,效果满意,现报告如下.     

婴儿扁桃体脓肿1例

患儿,男,8个月,因渐进性吸气性呼吸困难7 d于2003年6月11日入院。体检:T 37.1℃,P 11次/min,R 22次/min。精神可,口唇无紫绀,未见三凹症,平卧后有轻微喉鸣音,心肺腹及神经系统检查未见异常。双耳及鼻腔检查无异常。咽部检查可见右扁桃体呈球形肿胀,将悬雍垂挤向对侧,色鲜红,表面有少许脓液,腭咽弓及腭舌弓黏膜无充血及隆起,软腭无肿胀,左扁桃体正常。诊断为右扁桃体脓肿。无异物史。足月顺产第1胎,母乳喂养,按时接种疫苗。急查血常规:WBC 13.6×109/L;L:0.423,N:0.561;RBC 5.7×1012/L;Hb96 g/L;MCV 74 fL;MCHC 310 g/L。当日23∶…     

日本扁桃体周脓肿：724例研究

虽然抗生素治疗扁桃体周脓肿,已降低了死亡率,但严重并发症如颈深部脓肿、纵隔障炎仍有发生。本文分析日本Kyorin大学医院1988年1月-1999年12月收治的724例扁桃体周脓肿,男541例,女183例,     

Two cases of peritonsillar abscess complicated by von Willebrand disease

Von Willebrand disease (vWD) is a common hereditary bleeding disorder resulting from a quantitative and/or qualitative deficiency of von Willebrand factor (vWF). We report two cases of peritonsillar abscess complicated by vWD. A 46-year-old Japanese man was intravenously administered factor VIII clotting antigen (500U×3 days)and platelet transfusion (10U), when before puncture was performed. After puncture, his symptoms promptly improved with the administration of the antibiotic doripenem (DRPM, 1.5g/day). He left our facility one week later and had no recurrence of symptoms. A 24-year-old Japanese woman was intravenously administered factor VIII clotting antigen (4500U×3 days) and desmopressin (DDAVP) before undergoing a puncture. Her symptoms promptly improved with DRPM treatment (1.5g/day). The patient left our facility one week later. However, the peritonsillar abscess recurred in three weeks. Afterwards, tonsillectomy was enforced three months later. Intravenous factor VIII clotting antigen (4500U×2 days) and platelet transfusion (10U×1 day) had been used before tonsillectomy. We therefore suggest that a peritonsillar abscess in patients with vWD can be safely treated by factor VIII clotting antigen and DDAVP at the appropriate disease stage and by performing paracentesis for the acute phase or tonsillectomy for the chronic phase.     

Bilateral peritonsillar abscesses

In the discussion about the management of the peritonsillar abscess (PTA) in regard to the pros and cons of tonsillectomy à chaud versus à froid, the risk of obscure contralateral abscesses is often neglected. To the authors knowledge, there are only a few series of PTA being analyzed for the abscess rate of bilateral PTA. A group of 541 abscess tonsillectomies was retrospectively analyzed for the presence of a bilateral manifestation of peritonsillar abscess. Twenty-one patients (3.88%) had bilateral abscesses. None of these had been detected prior to the operation. Of the 541 patients, 2.22% had postoperative hemorrhages that had to be arrested under general anesthesia. Within the discussion about abscess tonsillectomy versus stab incision followed by interval tonsillectomy (à froid), the rate of almost 4% bilateral abscesses should be taken into consideration as dangerous complications such as mediastinitis could develop from the remaining abscess formation of the contralateral side.     

The usefulness of abscess tonsillectomy followed by intraoral drainage for parapharyngeal abscess concomitant with peritonsillar abscess in the elderly

Parapharyngeal abscess (PPA) may cause life-threatening complications and peritonsillar abscess (PTA) and tonsillitis frequently precede PPA. The optimal management of PPA caused by PTA has been the subject of debate with respect to the surgical approach. We present three cases of PPA concomitant with PTA in elderly patients. In two cases, the abscesses in parapharyngeal space were drained by abscess tonsillectomy followed by intraoral incision of the tonsillar bed. On the other hand, the third case did not undergo abscess tonsillectomy because of his refusal of surgery and needed extraoral drainage after the aggravation of PPA. Based on the experience of those three cases, it was suggested that abscess tonsillectomy followed by intraoral incision of the tonsillar bed might be a useful surgical approach for the drainage of PPA concomitant with PTA, especially in elderly patients.     

Four cases of acute epiglottitis with a peritonsillar abscess

We report four cases of acute epiglottitis with a peritonsillar abscess originating from the inferior pole of the palatine tonsil. All cases were male, and presented with acute onset of sore throat and dysphagia. Flexible laryngoscopy revealed swollen epiglottis and swelling at the base of tongue along the edge of the epiglottis in all cases. Computed tomography (CT) revealed the position and extent of a peritonsillar abscess. Surgical drainage was not performed. Abscesses decreased in size following intravenous antibiotics and corticosteroids. We surmise that inflammatory exudates extending widely in the pre-epiglottic space cause epiglottic swelling from oropharyngeal infection, the latter of which is thought to produce a peritonsillar abscess. We recommend CT examination for patients with a stable airway and swollen epiglottis, even if the swelling is mild. This will allow for exclusion of deep neck abscess and determination of the most effective treatment including intravenous antibiotics against anaerobe, incision and drainage of an abscess.     

Use of bacteriologic studies in the outpatient management of peritonsillar abscess.

OBJECTIVE: To examine whether obtaining bacterial Gram stain and aerobic/anaerobic cultures alters management of patients with peritonsillar abscess. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 221 cases of suspected peritonsillar abscess from July 1990 to February 1999 were analyzed with regard to outcomes and management patterns of those who had bacteriologic studies performed and those who did not. RESULTS: Pus was aspirated in 153 (69%). Eighty-two had bacterial studies performed whereas 71 did not. Of patients that followed up, all patients had complete resolution in the first group based on initial management. Three patients of the latter group had a complicated course secondary to dehydration and antibiotic noncompliance (P =.24). Of the 82 cultures sent, sensitivities were conducted on only 17 (21%). Nine of 17 grew organisms that were penicillin-resistant. No patient in the study had any treatment decisions based on microbiologic studies. CONCLUSION: In the routine management of peritonsillar abscess, bacteriologic studies are unnecessary on initial presentation. They should be reserved for patients with a high likelihood of infection by resistant organisms, i.e., diabetics, immunocompromised patients, and patients with recurrent peritonsillar abscess.