介入超声联合胆道镜微创化治疗胰周脓肿

目的探讨介入超声联合胆道镜建立治疗胰周脓肿微创化的模式。方法对52例确诊胰周脓肿患者实施介入超声穿刺置管引流,而后扩张窦道,胆道镜清创患者的临床资料进行回顾性分析。结果全组52例患者,50例经此方法治愈,治愈率96.2%,2例因穿刺引流效果欠佳改行开腹手术引流。50例患者平均治愈时间73 d,其中1例并发肠外瘘,2例并发出血,均经非手术治愈。所有患者随访3个月至1年以上,无胰周坏死组织残留。结论介入超声联合胆道镜治疗胰周脓肿是一种安全、有效的治疗方法,可予推广应用。     

经皮肾镜及胆道镜双镜联合及置管持续灌洗引流治疗胰周脓肿的体会

目的探讨采用经皮肾镜及胆道镜双镜联合及置管持续灌洗引流治疗重症急性胰腺炎(SAP)并发胰周脓肿的临床经验。方法对2例并发胰腺周围脓肿实施经腹腔及腹膜后途径穿刺置管,经皮肾镜联合胆道镜行胰周坏死组织清除及置管持续灌洗引流,对其临床资料进行回顾性分析。结果 2例患者均痊愈,无穿刺及手术并发症。结论经皮肾镜与胆道镜双镜联合及置管持续灌洗引流治疗SAP并发胰周脓肿的效果较好,安全、可靠,可以在临床中选择性推广应用。     

胆道镜经引流窦道清创技术治疗胰周脓肿

目的评价胆道镜经引流窦道清创治疗胰周脓肿的疗效。方法2008年1月～2011年12月,对81例开腹清创引流或超声引导穿刺引流未愈的胰周脓肿,胆道镜经引流窦道进入病灶内部,以活检钳和取石网钳取脓苔及坏死脱落组织,生理盐水灌洗脓腔,反复清创和持续引流,达到治愈。结果治愈76例,治愈率93．8％。4例因CT显示坏死区域靠近肠系膜血管或脾门部位改行开腹手术,1例因并发严重多器官功能衰竭死亡。76例治愈者接受胆道镜清创2—9次,平均5．1次,第一次镜下清创至治愈拔管时间25～132d,平均37d。胆道镜清创并发出血2例,肠漏1例,保守治愈。76例治愈患者随访3～38个月,其中〉12个月39例,无病灶残余。结论胆道镜完成对胰周脓肿病灶的清创,方法简单,临床效果可靠。     

肝切除术后胆道并发症的处理

目的 探讨肝切除术后胆道并发症的处理.方法 回顾性分析我们近8年行肝切除术588例患者的临床资料.结果 胆道并发症的发生率为6.2%(37例),其中胆漏26例(4.4%),发生胆道感染并肝脓肿6例(1.0%),术后出现胆道出血5例(0.8%),26例胆漏中再手术2例,经充分引流24例,均治愈:6例肝脓肿经引流及保守治疗治愈;4例胆道出血经保守治疗治愈,1例死亡.结论 充分引流、抗感染和营养支持可有效治疗胆道并发症.     

CT引导的经皮穿刺联合胆道镜治疗胰周脓肿

目的:探讨CT引导的经皮穿刺置管引流联合胆道镜治疗胰周脓肿的方法和效果。方法:5例重症胰腺炎合并胰周脓肿患者,在CT引导下行病灶穿刺引流,待窦道形成后,将窦道扩张,用胆道镜经窦道多次清除脓腔内坏死组织。结果:5例患者CT引导下穿刺置管均成功,每例患者经胆道镜脓腔清理2~6次,其中3例治愈;2例胰腺假性囊肿,经开腹行囊肿空肠吻合术治愈。无因穿刺、引流和胆道镜清理脓腔引发的并发症。结论:CT引导经皮穿刺、置管引流、窦道扩张和胆道镜清理,多种微创方法结合是治疗胰周脓的常有方法。     

介入超声置管引流联合胆道镜清创治疗胰周脓肿

目的 探讨介入超声置管引流后联合胆道镜治疗胰周脓肿的临床效果及应用价值.方法 选取2010年1月1日至2012年12月31日在我院行介入超声置管引流联合胆道镜治疗胰周脓肿患者40例为观察组,与35例行超声引导下置管引流的对照组进行对比分析.结果 与对照组比较,介入超声置管引流联合胆道镜治疗胰周脓肿可明显缩短术后住院时间,减少MODS和脓毒症的发生率（P＜0.05）.结论 介入超声置管引流联合胆道镜治疗胰周脓肿,方法简单、安全,临床效果可靠,是治疗胰周脓肿的有效方法.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

Psoasabszesse

BACKGROUND: A psoas abscess is a rarely encountered entity with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, increased morbidity, and prolonged or recurrent hospitalization. PATIENTS AND METHODS: Between January 1996 and January 2002 we treated ten patients (approximately 54.8, 5 males,5 females). These cases were analyzed retrospectively relative to a review of the literature. RESULTS: CT scanning was decisive in the final diagnosis of psoas abscess. Primary psoas abscess occurred in four cases and six patients had secondary abscesses. In all except one case, the psoas abscess was located on the right side. The causes of primary abscesses were retroperitoneal perforated appendicitis, paravertebral injections for lumboischialgia, Pott's disease, and repeated intravenous drug application in the groin. Five patients underwent retroperitoneal open drainage and four patients CT-guided drainage. One patient with retroperitoneal perforated appendicitis was treated by laparotomy. Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli were the most common infective agents. There was no postoperative mortality and no cases of abscess recurred. CONCLUSIONS: CT scan is a diagnostic "gold standard" for psoas abscess. CT-guided drainage is the method of first choice, but is not possible in all cases. Open retroperitoneal drainage is a standard method of treatment. Postoperative antibiotic therapy is obligatory and should be adapted individually.     

Retroperitoneal laparostomy: an effective treatment of extensive intractable retroperitoneal abscess after blunt duodenal trauma

BACKGROUND: Delay in surgical treatment and duodenal wound dehiscence are two major causes of extensive retroperitoneal abscess formation after blunt duodenal injury. This complication is traditionally treated with primary repair of the duodenal wound and drainage of the abscess through anterior laparotomy. Pyloric exclusion is sometimes added as an adjunctive procedure. The anterior approach, however, may result in inadequate drainage, and repeat surgery is sometimes needed. We reviewed our experiences and evaluated the effectiveness of retroperitoneal laparostomy for the treatment of retroperitoneal abscess with continuous soiling. METHODS: There were 52 blunt duodenal injuries during a 7-year period. Eleven patients developed extensive retroperitoneal abscesses. RESULTS: All 11 patients were treated with anterior laparotomy initially. Five patients recovered after this procedure. Six patients continued to have retroperitoneal abscesses and were under septic status. Two patients received another anterior drainage, and had recurrent abscesses later. Retroperitoneal laparostomy was performed for these six patients. After retroperitoneal laparostomy, daily wound care, and antibiotic treatment, all six patients recovered. Only two patients developed incisional hernia. CONCLUSION: Retroperitoneal laparostomy is effective in treating extensive intractable retroperitoneal abscess after blunt duodenal injury. Patients with the complications of duodenal leak and extensive retroperitoneal abscess should be treated with pyloric exclusion and drainage through anterior laparotomy first. If the duodenal wound does not heal after pyloric exclusion and retroperitoneal abscess persists, retroperitoneal laparostomy should be performed without further attempt to repair the wound.     

Percutaneous treatment of retroperitoneal abscesses

The retroperitoneal abscess is an uncommon disease, that must be treated by drainage. The progressive use of the percutaneous drainage, under ultrasound or computed tomography guidance (CT), has changed the therapeutical management and has demonstrated to be a valid alternative to surgical drainage. From 1986 to 1998, 16 patients with retroperitoneal abscesses were treated by percutaneous drainage (14 with CT and 2 with ultrasound guidance). This method eradicated the abscess in 13 cases, in 2 was necessary a new function to cure the abscess, and 1 patient, with a severe sepsis, died. Percutaneous drainage was the unique treatment used in 12 patients. In the remaining four, the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy. CONCLUSIONS: Percutaneous drainage of retroperitoneal abscesses has been established as a viable alternative to surgical intervention. This method can resolve the abscess or improve the patient' clinical status to undergo elective surgery.     

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目的 总结23例腹膜后脓肿诊断和治疗的经验,认识其易致多器官功能障碍综合征（MODS）的重要性。方法 对1993－1999年诊治的23例腹膜后脓肿的临床资料进行回顾性总结。结果 经腹部腹膜后脓肿引流20例,手术1－6次不等,B超引导下经后腰部穿刺置管引流3例。术后合并应激性胃粘膜损害发生消化道出血6例,成人呼吸窘迫综合征（ARDS）5例,急性肾衰2例,腹腔内出血1例,小肠瘘3例,空肠结肠瘘1例,霉菌感染3例。全组平均住院72天。死亡4例,其中因ARDS、ARDS并应激性胃粘膜损害大出血、ARDS并腹腔内血管破裂出血分别死亡1例,应激性胃粘膜大出血并空肠结肠瘘死亡,结论 作为术后并发症,腹膜后脓肿常易致MODS,对其及时诊断,充分有效的引流是预防MODS的关键。     

ERCP术后并发胰周及腹膜后脓肿的非手术处理

目的 总结ERCP术后并发胰周及腹膜后脓肿的非手术处理方法并评价其临床应用价值.方法 该组共收集2000年以来笔者遇到的5例ERCP后并发胰周及后腹膜脓肿的病人,所有病例均采用B超或CT引导下穿刺、于脓肿最低位处置人菊花头引流管引流.非手术处理还包括抗炎、抑酶药物的使用等.结果 所有病人均经引流等治疗后痊愈,引流时间在20～90 d不等,平均引流时间为52.4 d.总住院时间在35～165 d不等,平均91.8 d,无一例中转手术治疗.结论 穿刺引流术治疗ERCP术后造成的胰周脓肿或后腹膜脓肿安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点.穿刺点应尽可能选定在脓肿的最低位,可达到最佳的引流效果.     

ERCP术后并发胰周及腹膜后脓肿的非手术处理

目的 总结ERCP术后并发胰周及腹膜后脓肿的非手术处理方法并评价其临床应用价值.方法 该组共收集2000年以来笔者遇到的5例ERCP后并发胰周及后腹膜脓肿的病人,所有病例均采用B超或CT引导下穿刺、于脓肿最低位处置人菊花头引流管引流.非手术处理还包括抗炎、抑酶药物的使用等.结果 所有病人均经引流等治疗后痊愈,引流时间在20～90 d不等,平均引流时间为52.4 d.总住院时间在35～165 d不等,平均91.8 d,无一例中转手术治疗.结论 穿刺引流术治疗ERCP术后造成的胰周脓肿或后腹膜脓肿安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点.穿刺点应尽可能选定在脓肿的最低位,可达到最佳的引流效果.     

ERCP术后并发胰周及腹膜后脓肿的非手术处理

目的 总结ERCP术后并发胰周及腹膜后脓肿的非手术处理方法并评价其临床应用价值.方法 该组共收集2000年以来笔者遇到的5例ERCP后并发胰周及后腹膜脓肿的病人,所有病例均采用B超或CT引导下穿刺、于脓肿最低位处置人菊花头引流管引流.非手术处理还包括抗炎、抑酶药物的使用等.结果 所有病人均经引流等治疗后痊愈,引流时间在20～90 d不等,平均引流时间为52.4 d.总住院时间在35～165 d不等,平均91.8 d,无一例中转手术治疗.结论 穿刺引流术治疗ERCP术后造成的胰周脓肿或后腹膜脓肿安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点.穿刺点应尽可能选定在脓肿的最低位,可达到最佳的引流效果.     

胆道镜在胰腺周围脓肿治疗中的作用

目的拓展微创技术在胰腺周围脓肿(简称胰周脓肿)中的应用,总结胆道镜治疗胰周脓肿的经验和体会。方法回顾性分析我科2000年12月至2008年12月期间收治的36例胰周脓肿患者的临床资料,经超声介入穿刺置管,逐级扩张窦道,胆道镜清创,引流治疗,根据胰周坏死组织特点,充分利用胆道镜的灵活性,全方位多角度反复钳取、网取、负压吸引、彻底清除坏死组织和脓苔。结果全组36例施行B超介入穿刺置管引流,行单管穿刺置管3例,双管穿刺置管7例,三管穿刺置管及以上26例;胆道镜清创次数3～14次,平均5.6次。有6例患者经1～2次胆道镜清创后全身症状改善,血常规和体温恢复正常,饮食恢复,可带管出院。住院时间25～132d,平均76d。经胆道镜清创治愈33例,治愈率为91.7%(33/36);2例因胰周坏死组织范围较大,同时伴有腹腔内多处脓肿加行开腹清创引流,术后恢复较好,治愈出院;1例因并发严重多器官功能衰竭死亡。本组发生出血2例,肠外瘘3例。结论胆道镜对胰周脓肿清创方法简单、操作灵活、疗效可靠,改变了胰周脓肿只能手术引流的观点,减少了患者的创伤,实现了"微创损伤控制"的理念。     

Midline extraperitoneal approach for bilateral widespread retroperitoneal abscess originating from anorectal infection

IntroductionAnorectal abscess is one of the most common anorectal conditions encountered in practice. However, such abscesses may rarely extend upward and cause life-threatening medical conditions.Presentation of caseA 53-year-old woman presented with symptoms of anorectal abscess and evidence of severe inflammatory response and acute kidney injury. Computed tomography revealed a widespread abscess extending to the bilateral retroperitoneal spaces. Surgical drainage was performed via a totally extraperitoneal approach through a lower midline abdominal incision, and the patient had a rapid and uncomplicated recovery.DiscussionAlthough retroperitoneal abscesses originating from the anorectal region are rare, they are life-threating events that require immediate treatment. Percutaneous abscess drainage has been recently evolved; however, surgical drainage is required sometimes that may be challenging, particularly in the case of widespread abscesses, as in our case.ConclusionThe midline extraperitoneal approach reported here might be an effective surgical option for patients with bilateral widespread retroperitoneal abscesses.     

On percutaneous drainage of retroperitoneal collections: when is primary surgical drainage preferable?

Percutaneous drainage of retroperitoneal collections is a method employed with an ever-increasing frequency. The indication for primary surgical drainage of these collections is rapidly decreasing. Herein we describe what we consider to be the indications for primary surgical drainage of retroperitoneal collections illustrated by the recurrence of the abscess in 3 of our patients following adequate primary percutaneous drainage.