非特异性肾周围炎及肾周围脓肿诊治分析（附20例报告）

目的：报道我院近五年来收治的20例肾周围炎及肾周围脓肿病例,并对其诊断和治疗作出分析。方法：回顾性分析了自2005年1月～2010年8月期间住院的20例肾周围炎及肾周围脓肿患者的病例资料。收集分析的资料包括：临床症状及体征、合并症、影像学检查、实验室检查、细菌培养、治疗及预后。结果：20例病例中,肾周围炎5例,肾周围脓肿15例。最主要的临床表现是腰腹部疼痛、发热、腰腹部肿块,分别为16例（80％）、12例（60％）、5例（25％）。另外少见临床表现有血尿3例（15％）、尿频尿急尿痛2例（10％）、恶心呕吐腹胀1例（5％）。合并症可见糖尿病、泌尿系结石、慢性肾盂肾炎、输尿管移行细胞癌、腹膜后纤维化及肾盂输尿管连接部狭窄,分别为5例（25％）、5例（25％）、7例（35％）、1例（5％）、1例（5％）、1例（5％）。有7例患者做血、尿、脓培养,其中5例阳性（71．4％）,致病菌主要为：大肠埃希菌、肺炎克雷白杆菌、变形杆菌,混合感染为2例（28．6％）。在所有患者中,单纯抗生素治疗者5例（25％）,B超引导下穿刺引流者6例（30％）（4例复发需再次手术,其中3例行切开引流,1例肾切除）,开放切开引流者5例（25％）,行。肾切除者4例（20％）。19例患者痊愈出院,1例患者形成窦道,迁延不逾,无死亡病例。结论：随着B超、CT等影像学技术的进步和普及,肾周围炎及肾周围脓肿的诊断和治疗已有较大的改善,尽早行彻底引流及有力的抗生素治疗是疾病痊愈的关键。     

糖尿病合并肾周围脓肿6例外科治疗

目的：探讨糖尿病合并肾周围脓肿的治疗方法。方法：总结分析1990－1999年外科治疗糖尿病合并肾周围脓肿6例,并文献复习。结果：5例痊愈,1例因多器官脓肿、感染性休克死亡。结论：糖尿病合并肾周围脓肿是一种严惩的感染,易诱发多器官功能衰竭,应引起高度重视。     

肾周围感染41例临床分析

报告肾周围感染４１例，除２０例经应用大剂量抗生素治愈外，余２１例主要经手术引流治愈，其中９例切开引流，６例经皮穿刺抽吸或置管引流，６例经皮肾镜置管引流冲洗。对肾周围感染的病因、诊断、治疗，尤其是手术引流方式等进行了讨论，认为肾外因素致肾周围感染不容忽视，强调Ｂ尤其是ＣＴ可明确诊断并指导治疗。     

肾周产气性脓肿2例

例1 　女,5 5岁。寒战、高热1 0天,体温最高达40℃,无尿频、尿急、尿痛、脓尿等。体检:神清,心、肺、腹正常,有糖尿病史7年。检查血常规白细胞2 0×1 0 9/L ,血糖1 3mmol/L。CT示左肾周被不规则软组织影包裹,CT值2 8Hu ,其中散在大小不等的气体样低密度影;增强扫描示肾实质、集合系统正常,肾周软组织影不强化。诊断为肾周产气性脓肿。控制血糖,应用抗生素,经皮穿刺置管,引流出灰白色黏稠脓液,含气体。脓液细菌培养有肺炎克雷白菌粒,尿细菌培养阴性。因引流不畅,改为切开置管引流。2 0天后,引流液明显减少,症状完全消失。拔管,继续口服抗…     

肾周脓肿25例的诊断与治疗

目的：提高肾周脓肿的诊断与治疗水平。方法：回顾性分析25例肾周脓肿患者的临床资料。结果：25例患者明确诊断为肾周脓肿,72％患者尿培养阳性,CT确诊率92％。3例(12％)死亡。10例患者脓肿直径1.8cm,单独使用抗生素治疗平均住院10d;11例脓肿平均直径11cm,采用抗生素联合经皮穿刺引流治疗,平均住院30d;4例最后进行了外科探查和肾切除。结论：肾周脓肿临床变化特点并不典型,CT检查是目前确诊最可靠的方法,通过明确的分期以获得理想的疗效。     

产气性肾周脓肿1例

患者,男,41岁.入院前6天起无明显诱因出现左腰部胀痛,呈持续性阵发性加重,无放射痛,期间伴有寒战、高热,体温最高41℃,不伴有恶心、呕吐,无尿频、尿急、尿痛、脓尿及肉眼血尿,在外院按"肾结石"给予止痛、解痉、抗感染治疗,症状无明显缓解,急诊入我院.体检:心、肺、腹正常,肾区、输尿管走行区无压痛,左肾区叩击痛.既往有先天性多囊肾病史,右肾萎缩,发现血糖升高1年,未予治疗.实验室检查:白细胞为10.6×109/L,GR89.4%,血糖25.01 mmol/L,肌酐165.9 μmol/L;尿糖( ),尿白细胞和尿细菌培养均阴性.     

B超导向穿刺抽吸治疗肾周围脓肿15例报告

报告B超导向经皮肾周围穿刺抽吸治疗肾周围脓肿15例,14例经1～3次穿刺抽吸治愈;1例改用经皮肾周围穿刺置管引流。全组无并发症与死亡,近期无复发。文中详述了本方法的操作步骤、注意事项,讨论了其优点。     

肾皮质脓肿4例

肾皮质脓肿是较少见的肾脏感染性疾病 ,山东省立医院和山东医科大学附属第二医院 1 995年 6月～ 1 998年 1 0月收治本病患者 4例 ,均在应用广谱抗生素的同时及时行外科手术引流 ,取得明显疗效。报告如下。1　临床资料本组 4例 ,男 3例 ,女 1例 (患糖尿病 0 .5年 )。年龄 1 9～     

置管冲洗法治疗肾周围脓肿的研究(附18例报告)

目的:探讨肾周脓肿的有效治疗。方法:采用肾周围脓肿常规切开排脓加置导管冲洗另戳口引出,伤口一期缝合的方法治疗18例患者。结果:18例切开脓肿后排出脓液80～700ml,7～9天拆除缝线,所有患者伤口都一期愈合。住院10～15天,平均11天。结论:此法简单易行,效果较好,便于推广。     

肾皮质脓肿2例报告

肾皮质脓肿是一种由细菌经血液进入肾实质引起的严重感染，临床较为少见。我院自2001年至2002年收治2例，疗效满意，现报告如下。     

Perinephric angiomyolipoma: A unique development pattern surrounding the kidney

We report a case of a 31-year-old man with extrarenal angiomyolipoma of the perinephric space. He presented with asymptomatic macrohematuria. Computed tomography of the abdomen revealed a large perinephric mass which was separated from the right kidney and its unique growth appeared to have surrounded the kidney. Extrarenal angiomyolipomas of the perinephric fat are rare and they should be considered in the differential diagnosis of a retroperitoneal mass where asymptomatic macrohematuria was presented at the onset.     

Perinephric urinoma secondary to neurogenic bladder with vesicoureteral reflux: Report of an adult case

We report a case of infectious perinephric urinoma in a 73-year-old woman who had a neurogenic bladder with vesico-ureteral reflux. The patient was admitted to our emergency room with right lumbago and high fever. Ultrasounds and computed tomography demonstrated a right large perinephric cystic mass, bilateral hydronephrosis and much residual urine. Percutaneous drainage of the cystic mass was performed with an indwelling urethral catheter. The content of the mass was urine infected with Escherichia coli. Antibiotic therapy was performed successfully and we then examined the cause of the urinoma. A urodynamic study demonstrated a low-compliance small bladder and detrusor-sphincter dyssynergia. A voiding cystourethrogram revealed right grade III vesicoureteral reflux. The patient was unable to be cleared with intermittent catheterization and had an indwelling urethral catheter inserted. In 1 year, the voiding cystourethrogram showed no vesicoureteral reflux and the patient was well with no evidence of recurrent urinoma without the urethral catheter. There have been only two reported cases of urinoma caused by neurogenic bladder with vesico-ureteral reflux in children and this is the first case reported in an adult.     

肛旁脓肿行Ⅰ期根治性手术疗效的探讨

目的：探讨肛旁脓肿行Ⅰ期根治性手术的疗效。方法：对78例肛旁脓肿患者交叉设计分成两组。分别行Ⅰ期根治性手术（RS）和单纯脓肿切开引流（ID），比较术后疗效。结果：RS组病人术后形成肛瘘的发生率远低于ID组。而并发症却无升高趋势，且明显缩短了伤口愈合时间。结论：Ⅰ期根治性手术治疗肛旁脓肿疗效满意，临床使用价值高，值得推广。     

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.     

Serum Lysozyme (Muramidase) Levels in Intra-Abdominal Abscesses: An Experimental Study

The role of serum lysozyme in the presence of intra-abdominal sepsis was studied to act as an adjunct to various other modalities used for diagnosing intra-abdominal abscesses. Lysozyme (muramidase) is a bacteriolytic enzyme located within phagocytic cells including leukocytes. We measured serum concentrations of lysozyme by a standard turbidimetric method on three groups of murine models. One group underwent caecal ligation and puncture (CLP), the second group underwent a sham operation, and the third group was used as controls. In mice with intra-abdominal abscesses secondary to caecal ligation and perforation (n = 30), the serum lysozyme levels were increased compared to the sham-operated mice (n = 30) and controls (n = 30) (p = <0.001). In this study, serum lysozyme levels have a high sensitivity and specificity related to the presence of an intra-abdominal abscess in mice. Clinical studies are required to demonstrate its role in humans.     

Spontaneous Abscesses of the Abdominal Wall,Omentum and Abdominal Cavity Caused by Group G Streptococci: A Case Report

We report the first case, to our knowledge, of spontaneous abscess of the abdominal wall, omentum and abdominal cavity caused by group G streptococci. A 52-year-old diabetic woman presented with abdominal tenderness and weight loss that had persisted for a few weeks. CT scan showed several abscesses of the abdominal wall, omentum and abdominal cavity. The abscesses were drained laparoscopically and antibiotics were given postoperatively. Biopsies and cultures showed group G streptococci. The patient recovered without any complication and left our hospital on the 17^th postoperative day.     

一期根治术治疗肛门直肠周围脓肿临床观察(附46例报告)

目的:探讨一期根治术治疗肛门直肠周围脓肿的疗效。方法:对80例肛门直肠周围脓肿患者随机分为两组,分别行一期根治术(治疗组,48例)和单纯脓肿切开引流术(对照组,32例),比较术后疗效。结果:治疗组和对照组术后愈合时间分别为28d和41d,肛瘘的发生率分别为2.08%和84.38%,1年复发率分别为4.17%和25%,两组差异有统计学意义。结论:一期根治术治疗肛门直肠周围脓肿疗效好,肛瘘的发生率和1年内复发率低,值得临床推广应用。     

Abscesses caused by “dropped” stones after laparoscopic cholecystectomy for cholelithiasis: A Report of three cases

While laparoscopic cholecystectomy is a standard therapeutic option for gallbladder stones, it is associated with a significant risk of injury to the gallbladder wall, which may result in the dispersion of free stones within the peritoneal cavity. However, the incidence and consequences of these dropped stones remains unclear. We report herein the cases of three patients in whom abdominal abscesses developed as a result of dropped stones during this procedure. Of particular interest was the relatively long interval from the procedure to the onset of symptoms and the unusual progression of the inflammation. These case reports strongly reinforce the risk of dropped stones during laparoscopic cholecystectomy.