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。     

一期切开引流加挂线术治疗肛管直肠周围脓肿

目的：探讨肛管直肠周围脓肿的手术治疗。方法：回顾性总结34例急性肛管直肠周围脓肿的病例，分析一期切开引流加挂线术的手术方法、注意事项及疗效。结果：34例患者术后形成肛瘘1例，脓肿再发1例，需要再次手术者为5.9%（2／34）。结论：一期切开引流加挂线术治疗肛管直肠周围脓肿可减少肛瘘及脓肿复发率，具有明显的优越性。     

肾皮质脓肿的诊断与治疗—附13例报道

目的 提高肾皮质脓肿的诊断与治疗。方法 对1991年3月．2004年6月收治的13例肾皮质脓肿病例的诊断与治疗进行回顾性分析。结果 抗炎治愈1例，经皮肾脓肿穿刺1例因引流不畅改行脓肿切开引流后痊愈。9例行脓肿切开引流后痊愈。误诊2例，均行根治性肾切除术。结论 肾皮质脓肿的诊断需结合临床表现：实验室检查、影像学检查综合分析，脓肿切开引流是主要的治疗方法。     

输尿管镜钬激光碎石术治疗合并急性肾感染的输尿管结石20例报告

目的探讨输尿管镜钬激光碎石治疗并发急性肾感染的输尿管结石的可行性和安全性。方法对20例并发急性肾感染的输尿管结石患者施行输尿管镜钬激光碎石术,将结石粉碎至3mm以下。对合并输尿管息肉者,则将息肉切除。结果所有病例施行输尿管镜钬激光碎石术均1次将结石击碎,3例结石碎块较大上滑人肾盂,感染控制后辅以体外冲击波碎石清除结石残片。16例7d内体温降至正常,腰痛症状消失。2例因肾积脓,双J管引流不畅,B超定位下行经皮肾穿刺引流而痊愈。1例肾周脓肿迁延不愈,取腰部竖直小切口切开引流而治愈。1例肾皮质脓肿辅以抗菌治疗,2周后复查病灶吸收。站论输尿管镜钬激光碎石急诊治疗并发急性肾感染的输尿管结石是一种安全有效的方法,能及时控制急性肾感染,防止重症肾感染的出现。     

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。     

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。     

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。     

肾囊性疾病和肾盏憩室的腔镜下切开内引流术

目的：探讨经皮。肾镜及逆行软性输尿管肾镜下切开内引流术治疗。肾囊性疾病和肾盏憩室的安全性和可行性。方法：回顾性分析2010年1月～2013年2月对23例患者采用经皮肾镜及逆行软性输尿管肾镜下肾囊肿或肾盏憩室内切开引流术的临床资料。其中单纯肾囊肿5例,肾盂旁囊肿11例,肾盏憩室6例,多囊肾1例。囊肿、憩室直径平均4．7cm。手术方法采用全麻,顺行经皮。肾镜或逆行软性输尿管。肾镜下观察囊肿憩室的解剖位置及形态。直视下用钬激光将憩室口内切开扩大或凸起的菲薄囊壁切开一定范围开窗引流,使之与集合系相通。术后留置双J管引流。结果：23例患者均手术成功。手术时间36～75rain,平均48．9min。术后无大出血、严重感染、尿漏等并发症。术后随访3～24个月,11例囊肿消失,5例囊肿明显缩小,6例肾盏憩室消失,1例多囊肾囊肿（直径〉2cm者）数量明显减少。结论：经皮肾镜及逆行软性输尿管肾镜下内切开引流术治疗肾囊性疾病和肾盏憩室具有安全、有效,恢复快的特点,远期疗效有待进一步观察随访。     

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。     

肛管直肠周围脓肿的诊断和治疗(附110例报告)

目的 探讨肛管直肠周围脓肿的诊断和治疗。方法 对110例肛管直肠周围脓肿病例进行了回顾性分析。结果 确诊率为100％。102例行单纯脓肿切开引流,8例行脓肿切开引流 内口切开或挂线,94例使用抗生素。随访病例中,单纯脓肿切开引流的脓肿复发率为13.9％,后遗肛瘘发生率为71.2％。脓肿切开引流 内口切开或挂线无1例脓肿复发或后遗肛瘘发生。结论 肛管直肠周围脓肿大多可作出诊断,脓肿切开引流 内口切开或挂线为治疗肛管直肠周围脓肿的最佳术式,抗生素的使用不应作为常规。     

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.     

Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management

PURPOSE: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and surrounding tissues seen mostly in diabetic patients. Diagnosis and adequate therapeutic regimen are controversial. We reviewed the clinical presentation, diagnosis and aspects of surgical management of patients presenting with severe EPN. PATIENTS AND METHODS: Patients with EPN managed in our unit between 1996 and 2004 were reviewed. Diagnosis was confirmed by CT scan appearance of gas in the renal or perirenal area in a very ill patient. We compared the outcome of immediate nephrectomy with drainage of perinephric abscesses in patients presenting with severe EPN. RESULTS: Seven patients were managed in our unit during the 8-year period. All patients were diabetic and women outnumbered men (6:1). Renogram in all 7 patients showed renal function of affected kidney to be less than 15% in 6 patients. Escherichia coli was isolated in all patients from either urine, blood or perinephric pus. Management consisted of intensive resuscitation, control of blood glucose and use of intravenous antibiotics. Emergency nephrectomy was performed in 3 patients, delayed nephrectomy after an initial period of percutaneous drainage in 2 patients, incision and drainage in one patient and immediate percutaneous drainage was performed in one patient. One patient died 5 days post-nephrectomy of myocardial infarction. Patients who had immediate nephrectomy recovered quicker (18-21 days) and had no postoperative complications. Patients who had incision and drainage, or percutaneous drainage presented with recurrent discharging sinuses or perinephric abscesses requiring further surgical interventions and spent longer time in hospital (28-37 days). CONCLUSION: Patients with severe EPN often present in extremis and require intensive medical treatment. The diagnosis must be entertained in diabetic women presenting with flank pain and septicemia. The function of the affected kidney is often very poor and early nephrectomy offers the best outcome. Percutaneous drainage or incision and drainage of the abscess may be performed in patients too ill for immediate formal nephrectomy.     

Perinephric abscesses in the neurologically impaired

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document the occurrence and management of large perinephric abscesses in neurologically impaired patients at high risk for this infectious complication. SETTING: US Veterans Affairs hospital. METHODS: The records, radiographs, operative findings and outcomes of all patients who presented with perinephric abscesses evident on physical exam within the last 5 years were reviewed. RESULTS: Four patients presented with large perinephric abscesses evident on physical examination. All had severe neurologic impairment with high sensory levels; three had spinal cord injuries, one had advanced multiple sclerosis. All had neurogenic bladders and recurrent urinary tract infections. The diagnosis was made through a combination of history, physical examination and computed tomography (CT) examination. All were found to have upper tract obstruction. All were managed with immediate abscess drainage and three had elective nephrectomy once the infection had resolved. No patients died of their perinephric abscess. CONCLUSIONS: These four cases illustrate that although advances in antibiotics, imaging and percutaneous management have improved the speed of diagnosis and reduced the mortality in patients with perinephric abscesses, the neurologically impaired population continues to remain at significant risk for the development and the delayed diagnosis of these morbid renal infections.     

Are routine microbiological investigations indicated in the management of non-perianal cutaneous abscesses?

BACKGROUND: It is common practice to take a specimen of pus for microscopy and bacterial culture during drainage of abscesses. The aim of this study was to determine if routine culture and sensitivity had any therapeutic value in the care of patients with non-perianal cutaneous abscesses. PATIENTS AND METHODS: A retrospective analysis ofall patients undergoing drainage ofa cutaneous abscess during a two year period (June 2003 - June 2005) was performed. Patients were identified from the hospital database and theatre records, and those with perianal, pilonidal or surgical wound sepsis were excluded. Notes were reviewed for clinical details, culture results, subsequent admissions and attendance at follow-up. RESULTS: Of the 239 patients treated during this period, 74 patients had 77 operations to drain abscesses that matched the inclusion criteria. Specimens were sent from 52 (67.5%) procedures. Only 65.4% had an organism identified, of which methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism (36.5%). Forty-one point six per cent of patients received antibiotics as part of their treatment. The results of the bacterial culture and antibiotic sensitivities were not known prior to discharge of any patient. CONCLUSION: This study shows that bacteriology swabs are frequently taken during incision and drainage of non-perianal cutaneous abscesses and had little impact on the subsequent treatment, though these results may not be applicable to immune-compromised patients.     

Retroperitoneal abscess: 7-year experience of 29 cases in a tertiary care center in Taiwan

ObjectiveRetroperitoneal abscess is a rare condition with an insidious onset and difficult diagnosis. It can occur from various origins. To analyze our experiences, we conducted a case series study of retroperitoneal abscess cases in our hospital.Materials and methodsTwenty-nine patients in whom retroperitoneal abscesses were diagnosed at our hospital were reviewed from January 2007 to January 2014 for the purpose of analyzing the presenting symptoms, diagnostic tools, microbiology, treatment methods, and mortality.ResultsOf the 29 patients reviewed, a genitourinary origin was the most common source and accounted for 51.7% of the patients, and perinephric abscess was the main type of abscess. Diabetes mellitus, previous surgery, and an immunocompromised condition were common factors. The common clinical manifestations were fever (65.5%), back pain (37.9%), and abdominal pain (20.7%). Escherichia coli was the most prevalent pathogen (31.3%), followed by Klebsiella pneumoniae (25%). A polymicrobial pathogen accounted for 13.8% of infections. An anaerobic pathogen was only found in one case of gastrointestinal origin. Computed tomography and magnetic resonance imaging were found to be accurate diagnostic tools with sensitivities of 88.5% and 100%, respectively. Percutaneous drainage was commonly performed for abscesses of genitourinary origin, whereas surgical drainage was preferred in abscesses of gastrointestinal origin. The overall mortality rate was 3.4%, with one death reported.ConclusionRetroperitoneal abscesses exhibit an insignificant clinical manifestation and varied origin. Both computed tomography and magnetic resonance imaging were shown to be reliable tools for early diagnosis. K. pneumoniae was found to be a prevalent pathogen in the Taiwanese patients, especially in cases of perinephric abscess. The treatment methods for retroperitoneal abscess varied according to the origin and presentation.     

Renal and perirenal abscesses in patients with otherwise anatomically normal urinary tracts

PURPOSE: We characterized evaluation, management and outcomes in a group of patients diagnosed with renal and perirenal abscesses who had otherwise anatomically normal urinary tracts. MATERIALS AND METHODS: We reviewed our experience with renal/perirenal abscesses at University of Texas Medical Branch from 1991 to 2002. Treatment was determined by physician preference in each individual. RESULTS: Of 70 patients with renal/perirenal abscesses 26 had otherwise anatomically normal urinary tracts, 24 (92%) had at least 1 possible contributory factor, such as diabetes mellitus, and only 38% had the correct diagnosis at initial presentation. The abscess was intranephric in 39% of cases, intranephric and perinephric in 19%, and perinephric only in 42%. Of the 26 patients 18 were treated with percutaneous drainage or aspiration of the abscess and 12 (66.7%) had positive cultures. Eight of the 12 patients (67%) with positive abscess cultures had the same organism in urine and/or blood. All 26 patients were treated with broad-spectrum intravenous antibiotics. In most patients abscess size influenced additional treatments, such as percutaneous needle aspiration or catheter drainage. None of the patients required open surgical drainage, nephrectomy or nephrostomy tube placement. At a mean followup of 10 months all patients had complete radiographic resolution of the abscess without further complications except 1 who had pyelonephritis and another who was found to have a poorly perfused kidney. CONCLUSIONS: With accurate diagnosis and minimally invasive therapy patients with renal and/or perirenal abscesses and otherwise anatomically normal urinary tracts have excellent functional and anatomical outcomes.     

Medical education in China: Historical background,present status,and further development

Sixty-five abscesses, including 6 infected biliary systems and 15 sterile fluid collections, were treated by percutaneous catheter drainage in 77 febrile patients who were evaluated by computerized tomograhy or ultrasonography for intraabdominal infection. Percutaneous catheter drainage and systemic antibiotic administration without surgery provided satisfactory control of infection in 52 of 65 abscesses (80 percent). Catheter drainage followed by surgical exploration for abscess control was performed in an additional 5 of the 65 abscesses (7 percent). Nine deaths (14 percent) occurred in the abscess group of 64 patients. In 15 patients, aspirations, Gram stain, and culture of the abnormal fluid collection revealed sterile fluid. Drainage with a single catheter allowed complete resolution in 14 of 15 sterile collections. Surgery was performed electively in one patient with a fistula from a pancreatic pseudocyst in the small bowel. No deaths occurred in the noninfected group of 15 patients, 2 of whom underwent drainage of coexisting abscesses.     

Retroperitoneal abscesses--analysis of a series of 66 cases

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.     

Management of major blunt renal lacerations: is a nonoperative approach indicated?

OBJECTIVES: The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma. METHODS: Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. RESULTS: In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension. CONCLUSION: For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.