腔内高负压冲洗引流治疗深部组织感染8例报告

目的探讨腔内高负压冲洗引流治疗深部组织感染的临床效果。方法对南昌大学第三附属医院2014年1月至2018年1月采用腔内高负压冲洗引流治疗的8例深部组织感染患者的临床资料进行回顾性分析,其中直肠损伤1例,坏死性筋膜炎1例,直肠肛门周围脓肿6例。结果8例患者均引流成功,预后良好。结论腔内高负压冲洗引流治疗深部组织感染,实现了脓腔内充分减压及冲洗,引流后症状缓解明显,恢复效果满意,具有积极的治疗价值。     

彩超提示下穿刺冲洗治疗儿童颌面间隙感染

目的:对儿童颌面间隙感染形成脓肿早期病例采用彩超提示下局部穿刺吸脓,药物冲洗脓腔,保守治疗,避免手术切开排脓遗留瘢痕。方法:儿童颌面间隙感染102例,在常规抗感染治疗的基础上采用彩超提示下经皮穿刺奥硝唑与庆大霉素冲洗治疗。结果:102例中92例经穿刺治疗后痊愈,10例无效作脓肿切开引流,有效率为90.20%。结论:彩超提示下穿刺冲洗治疗儿童颌面间隙感染具有创伤小、可操作性强、能有效缩短病程、愈后不留瘢痕等特点,是治疗颌面间隙感染脓肿形成早期的有效方法。     

超声引导下穿刺治疗颌面间隙感染164例临床分析

目的 探讨颌面间隙感染形成脓肿后的保守治疗方法 .方法 对2000 ～2009 年秦皇岛市第二医院口腔科收治的164 例颌面间隙感染病例在超声下穿刺,使用甲硝唑及庆大霉素药物灌洗治疗,对这组病例进行回顾性分析并就治疗方法 及治愈率进行评价.结果 164 例患者中145 例经超声引导下穿刺治疗局部肿胀消退,包块缩小,急性炎症基本控制.16 例穿刺治疗后脓肿变浅,皮下行脓肿切开引流,2 例急性期后手术切除,病理为炎性包块.1 例穿刺液涂片结核菌阳性,转传染科治疗.治疗有效率为88.41 %.结论 颌面间隙感染在脓肿形成早期采用经超声引导下穿刺抽脓治疗,可以尽早排除感染物脓液,局部应用药物浓度高,可以有效控制病情,缩短病程,降低治疗费用,避免切开排脓形成瘢痕,对深部脓肿、脓肿形成早期尤其适合.该治疗方法 操作简单,成本低,值得在临床推广.     

颈深部脓肿23例临床分析

目的 分析颈深部脓肿的发病原因、临床表现和治疗体会.方法 回顾性分析2003年1月至2009年10月本院收治的23例颈深部脓肿患者的临床资料.结果 23例患者的原发病:急性扁桃体炎4例,急性咽喉炎5例,牙源性感染2例,异物2例,不明原因10例;脓肿部位:咽旁脓肿14例,咽后脓肿5例,颌下间隙脓肿2例,气管前间隙脓肿2例;并发症:纵隔脓肿2例,气胸脓胸1例.21例行切开引流,2例自行破溃.13例应用2种抗生素(A组),10例用1种抗生素(B组);A组平均治疗时间明显短于B组[(10.6±6.2) d比(15.9±7.5) d,P<0.01].治愈21例(91.3%);死亡2例(8.7%),死于并发纵膈脓肿感染性休克1例,并发脓气胸1例.结论 颈深部脓肿一经确诊,应尽早切开引流,合理使用抗生素,积极控制并发症,以提高治愈率.     

改良式简易封闭负压法治疗阴囊脓肿的疗效观察

目的:观察改良式简易封闭负压引流技术在治疗阴囊脓肿中的临床疗效。方法:将阴囊脓肿切开排脓后41例患者随机分为试验组21例和对照组20例,试验组采用改良式简易封闭负压引流技术用于切口排脓,对照组切口采用常规换药方法,比较两组患者切口愈合效果及创面愈合时间。结果:试验组疗效明显高于对照组,试验组创面愈合时间明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。结论:应用改良式简易封闭负压引流技术治疗阴囊脓肿,可明显提高治疗效果,值得临床推广。     

改良负压封闭引流联合药物冲洗在颌面间隙感染中的护理

总结本科自2014年12月~2015年12月期间对10例颌面间隙感染病例行改良负压封闭引流联合药物冲洗创腔的护理经验和体会。主要包括对颌面部间隙感染患者行改良负压封闭引流技术为主的脓肿切开术,术后放置双套管道,用奥硝唑氯化钠及生理盐水持续冲洗创口及负压引流,维持有效的负压引流并保持管道和呼吸道通畅。认为改良负压封闭引流技术及联合药物冲洗口腔颌面部间隙感染,有利于感染创面的快速愈合、缩短住院周期、减少住院费用,提高患者及家属对治疗的满意度,是一种优于传统的脓肿切开引流术的理想方法。     

66例颈深部组织感染的临床分析

目的：探讨颈深部组织感染患者的临床表现、病原学及治疗体会。方法：对66例颈深部组织感染患者的临床资料进行总结分析。结果：上呼吸道感染22例，急性化脓性扁桃炎32例，咽喉及食道异物9例，不明原因3例。66例中61例行颈深部脓肿切开引流术加多联抗生素联舍治疗，5例行大剂量抗生素全身用药。63例康复，治愈率94％。3例死亡（2例咽旁脓肿合并败血症引起死亡，1例咽后壁脓肿合并心脏病死亡）。结论：颈深部组织感染一经确诊，应合理应用抗生素，对于脓肿形成的病例，应早日行脓肿切开引流术，积极控制并发症，才能提高治愈率。     

颈深部脓肿75例临床分析

目的探讨颈深部脓肿患者的临床表现及诊断、治疗经验。方法对2005年1月至2008年6月收治的75例颈深部脓肿患者的,临床资料进行回顾分析。结果颈深部脓肿临床类型有：扁桃体周围肿58例,咽旁脓肿8例,脓性颌下炎2例等。合并糖尿病5例。通过脓肿切开引流术,经颈-纵隔引流术,抗生素等综合治疗治愈72例,死亡3例。结论颈深部脓肿确诊后应及时切开引流,合理应用抗生素,控制伴发病和严重并发症,提高治愈率。     

牙源性下行性颌下、颈深部、纵隔、胸膜腔感染并脓肿形成一例

目的分析颌下、颈深部、纵隔、胸膜腔感染并脓肿形成的诊治方法。方法对1例牙源性下行性颌下、颈深部、纵隔、胸膜腔感染并脓肿形成的临床资料进行回顾性分析。结果患者为中年男性,因左颌下疼痛10 d伴高热就诊,行颌面、颈部、胸部CT检查及穿刺引流出粪水样恶臭引流液,诊断为牙源性下行性颌下、颈深部、纵隔、胸膜腔感染并脓肿形成,给予多腔隙脓肿切开引流术,并及时应用敏感抗生素及营养支持治疗后,痊愈出院。结论颌下、颈深部、纵隔、胸膜腔感染并脓肿形成治疗的关键在于早期诊断,及时手术有效充分引流,同时给予足量、广谱抗生素及营养支持治疗。     

颌面颈部间隙感染患者经小切口负压引流治疗效果观察

目的 探讨颌面颈部间隙感染患者经小切口负压引流治疗的临床效果.方法 将50例颌面颈部间隙感染患者按照入院顺序分为两组,均给予常规治疗,观察组在此基础上给予小切口负压引流治疗,对照组给予广泛切开引流术.比较两组术后愈合时间、皮肤瘢痕长度及宽度.结果 观察组术后愈合时间显著短于对照组(P＜0.01),瘢痕长度及宽度显著小于对照组(P＜0.01).结论 小切口负压引流治疗颌面颈部间隙感染患者临床疗效显著,有利于缩短术后愈合时间,缩小瘢痕范围,值得在临床推广应用.     

75例颈深部脓肿的护理

目的：总结颈深部脓肿患者的观察与护理。方法：对75例颈深部脓肿患者的临床治疗、观察与护理进行回顾性分析。结果：75例颈深部脓肿患者通过脓肿切开引流、颈-纵隔引流术,结合抗菌药物及营养支持等综合治疗和相关护理,治愈72例,死亡3例。结论：颈深部脓肿确诊后除及时切开引流、合理使用抗菌药物控制合并症及严重并发症以外,还应及时的观察,细致的护理,合理的饮食营养,促进患者早日康复,提高治愈率。     

Peritonsillar abscess. Why aggressive management is appropriate

Peritonsillar abscess is the most common deep neck infection in adults. Infections develop from purulent material collecting in the fascial spaces lateral to the capsule of the palatine tonsil. Infections are usually polymicrobial, and a significant number of anaerobes are isolated. The cornerstone of therapy is drainage of the abscess. With cooperative patients, careful permucosal needle aspiration is an accepted method of primary therapy. Large or recurrent abscesses require otolaryngologic consultation for adequate incision and drainage. Tonsillectomy may be necessary to prevent re-formation of abscess in patients with a history of recurrent tonsillitis.     

39例食管异物严重并发症的分析

目的：探讨食管异物严重并发症的治疗方法。方法：总结我院收治的39例食管异物严重并发症的临床资料。结果：食管内引流法9例，颈侧切开引流法15例，经颈纵隔切开引流去5例，3例剖胸取出异物，7例为食管癌。结论：食管异物早诊、早治疗方可避免发生严重并发症。食管周围脓肿、纵隔脓肿应根据脓肿部位、病人全身情况等灵活选择引流方法，加上全身抗感染、支持疗法，大多数病人可望痊愈。     

下咽异物致颈深部脓肿的诊治

目的探讨下咽异物迁移致颈深部脓肿的诊治方法。方法对下咽异物迁移至颈部致颈深部脓肿5例病人的临床资料进行分析。结果 5例病人经颈侧切开探查术全部治愈。结论在诊治下咽迁移性异物所致的颈深部脓肿时,应重视影像学的应用,治疗应在全麻下行颈侧切开探查术。     

超声在细菌性肝脓肿诊断及治疗中的应用

[目的]探讨分析细菌性肝脓肿的超声表现及超声诊断技术和介入性治疗的临床应用价值.[方法]回顾性分析经临床随访及超声引导下穿刺活检证实76例细菌性肝脓肿临床及影像学资料.[结果]肝脓肿随病理过程的变化临床及超声表现各不同,超声引导下穿刺活检可确诊,大部分可行超声引导下脓肿穿刺抽吸或置管引流,结合全身治疗,可使病程缩短.[结论]肝脓肿声像图复杂多变,超声仍为首选方法,超声引导下穿刺更具诊断意义,超声引导下穿刺引流疗效显著.     

39例食管异物所致严重并发症的治疗分析

本文对３９例食管异物所致严重并发症的治疗进行了分析。结果表明,食管内引流、颈侧切开引流经颈纵隔切开引流法等均有较好疗效。食管异物应早期就诊治治疗可避免发生严重并发症。对于食管周围脓胀、纵隔脓肿的切开引流可根据脓肿部位、病人全身情况等选择切开引流方法,加上全身抗感染、支持疗法,大众多数病人可获痊愈。     

Acute neck infections in children: who is likely to undergo surgical drainage?

Background

Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined.

Design/Methods

All visits to the study PED were examined in 2009 to 2010. Visits with the diagnosis of cervical lymphadenitis or abscess were identified. Records were retrospectively reviewed to determine the duration of symptoms, fever, previous antibiotic therapy, prior PED visit, size of neck swelling, fluctuance on physical examination, white blood cell count, and results of CT and/or ultrasound obtained in the PED. Data were analyzed to determine which of these characteristics were more likely to be associated with an abscess that was operatively drained.

Results

A total of 768 patients were evaluated for neck infections. One hundred twelve (14%) of these pediatric patients underwent abscess drainage in the operating room. Two hundred eighty-nine patients underwent a neck CT and/or ultrasound, of which 119 were positive for abscess. Factors associated with surgical drainage included fluctuance (odds ratio [OR], 18.92; 95% confidence interval [CI], 3.66-31.37), previous emergency department visit (OR, 2.79; 95% CI, 1.34-5.84), and age less than 4 years (OR, 3.01; 95% CI, 1.15-9.87). A recursive partitioning model stratified patients' risk for going to the operating room. Patients without fluctuance and with no prior emergency department visit, along with no prior antibiotic use, have less than 4% chance of having an abscess that necessitates surgical drainage.

Conclusions

Pediatric patients who are more likely to have a neck infection that necessitates surgical drainage can be stratified based on clinical characteristics. This knowledge may allow physicians to better predict the resource needs including hospital admission and emergent imaging for neck infection.     

Retropharyngeal and epidural abscess from a swallowed fish bone

Retropharyngeal abscess is not uncommon, but the incidence of epidural extension of a retropharyngeal abscess is very rare. Intraspinal involvement of the deep neck infection should be suspected if the patient has neurolgic deficits. Emergent surgical drainage and aggressive antibiotic treatment are necessary. The outcome is strongly associated with the level of neurologic function at the time of diagnosis. Contrast-enhanced computed tomography is an excellent diagnostic method for any deep neck infection. A case is presented in which a perforating pharyngeal foreign body (fish bone) induced a retropharyngeal and epidural abscess. The literature is reviewed to improve the early recognition and treatment of this complication of deep neck infection.     

Peritonsillar abscess: diagnosis and treatment.

Peritonsillar abscess, the most common deep infection of the head and neck that occurs in adults, is typically formed by a combination of aerobic and anaerobic bacteria. The presenting symptoms include fever, throat pain, and trismus. Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. After performing aspiration, appropriate antibiotic therapy (including penicillin, clindamycin, cephalosporins, or metronidazole) must be initiated. In advanced cases, incision and drainage or immediate tonsillectomy may be required.