Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration.

The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided needle aspiration in the treatment of prostatic abscess. Fourteen patients with prostatic abscess were evaluated with this technique and treated with sonographically guided needle aspiration. Using this technique, all cases (100%) had one or more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients (71.0%), the lesion showed internal septa or solid portion. The margins of the hypoechoic area were well defined and thick in 11 patients (79.0%) and poorly defined in 3 patients (21.0%). The estimated volume of the prostatic abscess ranged between 2 and 28 ml (mean, 12.0 ml). The presence of a pus collection within the prostate was confirmed by transrectal ultrasonographically guided aspiration in all patients. However, successful treatment of prostatic abscess with transrectal needle aspiration was done in 12 (86.0%) of 14 patients; the treatment failed in 2 (14.0%) of 14 patients. One patient was treated with perineal incision and drainage and the other with transurethral resection. The amount of pus drained ranged between 1 and 39 ml (mean, 12.0 ml). On follow-up transrectal ultrasonographic examination, no remaining abscess pocket was found within the prostate in any of the cases. One year later, the prostatic abscess recurred in one case. In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an effective method for treating prostatic abscess.     

Drainage of deep pelvic abscesses using therapeutic echo endoscopy

BACKGROUND AND STUDY AIMS: The purpose of this study was to evaluate the clinical efficacy of endosonographically guided transrectal aspiration and drainage by plastic stent of deep pelvic abscesses, using a therapeutic echo endoscope device. PATIENTS AND METHODS: Between September 2000 and June 2001, 12 patients (nine men, three women, mean age 67 years) were treated for a perirectal or a pelvic abscess using an endoscopic ultrasound (EUS) technique. The drainage of these fluid collections was performed under EUS guidance, using therapeutic EUS scopes with a large working channel. RESULTS: No major complication occurred during this study. Transrectal stent insertion succeeded in nine patients. In three patients, only aspiration was possible. Among the nine patients in whom a stent was successfully introduced into the fluid collection, complete drainage without relapse was achieved in eight patients (mean follow-up 10.6 months, range 6-14 months). The stent was removed endoscopically after 3 to 6 months. Drainage was incomplete in one patient (with a large abscess, diameter > 8 cm), who subsequently underwent surgical drainage. However, two out of the three patients in whom aspiration alone was performed developed a recurrence of the abscess and required surgical treatment. CONCLUSION: EUS-guided drainage of deep pelvic abscesses could offer an alternative treatment to surgery in the management of these postoperative complications.     

Percutaneous management of breast abscesses. An experience of 39 cases

This is a review of our experience with percutaneous drainage by means of needle aspiration or catheter drainage of breast abscesses under ultrasound (US) guidance, and a suggested management algorithm. A retrospective study of the 39 patients (36 women, 3 men; mean age: 28.9 years) with breast abscesses who were treated by percutaneous US-guided procedures over a period of 13 years (1989 to 2002) was carried out. Of the 36 women, 34 were nonlactating and two lactating. Needle aspiration was used in the cases of fluid collections < or = 3 cm and catheter drainage in fluid collections of > 3 cm. Postdrainage care and US evolutive controls were carried out on an outpatient basis. Fine-needle aspiration cytology was performed in masses unresolved after postdrainage. Mammography was performed in patients over 30 years old. In all cases, US examination revealed images of fluid collection. A single needle aspiration was sufficient in 19 cases; 3 patients needed a second aspiration to resolve the breast abscess. A total of 15 cases were resolved by means of percutaneous catheter drainage. In 2 of the 17 patients who underwent catheter drainage, the mass persisted postdrainage; histologic findings showed a chronic abscess requiring surgical intervention in one and a breast carcinoma in the second. Mean follow-up was 8.4 months. Recurrence of breast abscess occurred in 4 patients, and these were resolved by surgical excision. Percutaneous drainage procedures in breast abscesses are a safe and effective alternative to incision and drainage. Needle aspiration is employed in cases of small abscesses and catheter drainage in abscesses larger than 3 cm. Although, in chronic abscesses, the treatment of choice is surgical excision, percutaneous drainage remains as an intermediate therapeutic option.     

2000～2011年前列腺脓肿诊治文献的循证评价

目的循证评价近十年前列腺脓肿诊治文献,为临床实践提供参考。方法依据循证医学原理,应用文献计量学方法,全面检索PubMed数据库2000年1月～2011年4月前列腺脓肿诊治研究,纳入合格文献并评估文献质量、提取有效数据后以OpenO ce.org 3.8 Calc建立数据库进行分析,系统评价前列腺脓肿诊治文献。结果①初检共获得文献205篇,最终纳入符合标准的文献81篇,合计388例(4.79例/篇)患者。患者年龄分布为10天～83岁,除2篇文献涉及诊断试验外,其余79篇文献均为外科干预性研究。②81篇文献中无一篇为临床对照试验,病例数≥5例的16个研究(共311例)均为回顾性病例分析,其余65个研究为个案报道。③美国共发表13篇文献居首位(占16.5%),欧美国家共发表36篇(占44.44%),我国大陆研究明显薄弱,仅发表2篇英文研究。④前列腺脓肿发病低龄化。病原体包括真菌、细菌两大类,后者以G+球菌(葡萄球菌属)为主,次为G–杆菌(克雷伯菌属),少见病原体亦有发病,病因复杂且不同地区差异明显。易感因素概括为局部与全身因素两类,以糖尿病、肝硬化与下尿路操作、尿路感染最常见。⑤诊断涉及症状评估、体格检查、病原体鉴定、影像学检查(TRUS、下腹或骨盆CT、MRI)等。治疗包括一般处理、抗生素疗法与外科引流;手术径路分为经皮经会阴、经直肠与经尿道;经会阴/经直肠行TRUS、EUS或CT引导下细针穿刺抽吸、留置导管引流或切开引流,经尿道行TUR、TURP或TUIP引流,部分穿刺抽吸失败转为经尿道或经会阴切开引流,部分病例行尿流改道。⑥由于缺乏对比资料,未能获得不同术式孰优孰劣的结果。⑦除死于相关并发症外,结局良好。结论①前列腺脓肿文献丰富,但质量不高,均为回顾性研究或个案报道,且以欧美国家报道为主。②发病低龄化但任何年龄皆可发生,以G+球菌(葡萄球菌属)为主,次为G–杆菌(克雷伯菌属),地区差异明显。③易感因素以糖尿病、肝硬化与下尿路操作、尿路感染最常见。④在临床评估的基础上,以TRUS/盆腔CT/MRI与实验室检查确诊本病。⑤抗菌素使用宜有病原学依据,注意大肠埃希菌耐药性问题。视具体情况可个体化采用保守治疗、TRUS/EUS或CT引导下穿刺抽吸、留置导管引流或经尿道微创引流;若脓肿穿破前列腺包膜或穿透肛提肌则宜经会阴切开引流;术后应密切随访。     

Splenic abscess: Sonographic diagnosis and percutaneous drainage or aspiration

During a recent 5-year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound (US) examination. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. The latter four patients had developed splenic microabscesses with a diameter of <1.5 cm. The larger abscesses showed an irregular wall, weak or no internal echoes, ovoid or round in shape, and accompanied by mild to moderate distal acoustic enhancement. Wedge-shaped abscesses were typically noted in patients with infectious endocarditis and septic embolism. US-guided percutaneous drainage was done in five patients (abscesses > 4 cm). Simple aspiration in conjunction with antibiotic administration was done for seven smaller abscesses (diameter <3.5 cm) in five patients. A second drainage, either for a dislodged catheter or a recurrent abscess, was performed in two cases. All patients had uneventful clinical course following this therapeutic approach.     

Combined transrectal sonographic and fluoroscopic guidance for deep pelvic abscess drainage.

We attempted to determine the feasibility, safety, and success of transrectal catheter drainage of deep pelvic abscesses using a combination of transrectal sonography and fluoroscopic guidance. In this retrospective review of five cases, transrectal catheters were placed within abscess cavities over a 20 month period. Clinical improvement was prompt, catheters were removed within 7 days, and no complications were detected. No patient required further intervention (follow-up 2 to 20 months). Transrectal sonographically guided catheter drainage proved to be safe and effective in our series. This method is a promising alternative to the posterior (sciatic notch) approach when the anterior transabdominal approach is contraindicated.     

扩散加权成像检测软组织感染脓腔

目的 探讨DWI在检测软组织感染有无脓腔形成中的价值。方法 收集14例经临床确诊的细菌性软组织感染伴脓腔形成病例,其中10例接受B超引导下抽吸排脓,2例接受手术切开排脓,1例接受病灶切除术经病理证实为软组织感染,1例病灶切除术后病理证实为腱鞘囊肿伴感染。使用1.5T MR行常规MR平扫、增强扫描及DWI。结果 14例共15个脓腔,其中13例为单发、1例为多发;多房脓腔3个,单房脓腔12个,11个脓腔呈稍长T1长T2信号,增强扫描均无强化,所有脓腔DWI均呈不同程度的高信号;ADC图显示12个脓腔的水分子弥散明显受限、2个不均匀受限、1个受限不明显。脓肿壁及分隔DWI均无法分辨、ADC图上8个尚可分辨、增强扫描均呈明显强化且显示清晰。周围炎性水肿均呈长T2信号,其范围于T2W FATSAT 或STIR序列上最易分辨,于T1WI和DWI上最难分辨;增强扫描水肿区呈广泛连续的片状强化和(或)散在肌束样、线条状、斑片状不规则强化。结论 DWI可作为MR评价软组织感染是否形成脓腔的重要辅助序列,尤其对于磁共振对比剂禁忌者;常规MRI对显示感染范围、脓肿部位及其结构具有优势。     

Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope.

STUDY AIMS: The purpose of this study is to evaluate a new drainage technique for pancreatic pseudocysts or pancreatic abscesses entirely guided by endoscopic ultrasound (EUS) and using an interventional echo endoscope with a linear curved array transducer. PATIENTS AND METHODS: Between July 1996 and September 1999, EUS-guided drainage of a pancreatic pseudocyst or pancreatic abscess was carried out in 35 patients (26 men, 9 women; mean age 56.7, range 29-69). The mean size of the 35 pancreatic cysts was 7.8 cm (4-12 cm). Pancreatic pseudocysts were located in the head of the pancreas in two cases, in the body in six cases and in the tail in seven cases. On the other hand, the pancreatic abscesses were located in the tail of the pancreas in 17 cases and in the gastric wall in three cases. The EUS instrument used was the FG 38X endoscope manufactured by Pentax-Hitachi. RESULTS: No major complication occurred except in one case of a pneumoperitoneum, which was managed medically. Placement of the 7-F nasocystic drain was successful in 18/20 cases of pancreatic abscess. Surgery was performed in the two other patients. Concerning the pancreatic pseudocysts, placement of an 8.5-French stent was successful in 10 patients and of a nasopancreatic drain in five patients. In one case, only a puncture-aspiration was performed. One recurrence among the 15 pancreatic pseudocysts and two relapses of the 18 pancreatic abscesses have been observed, over a mean follow-up of 27 months (6-48 months). EUS-guided drainage was successful in 31/35 patients (88.5%); only four patients with pancreatic abscesses underwent surgery. No bleeding occurred during the time of this study. CONCLUSION: Internal drainage of pancreatic pseudocysts and abscesses exclusively performed with an echo endoscope is a safe and efficient method which should be evaluated further in larger studies.     

Percutaneous drainage of abscesses in patients with Crohn's disease

The hospital courses of 9 patients with intraabdominal abscesses and Crohn's disease who underwent abscess drainage utilizing percutaneous techniques were reviewed. Percutaneous methods brought about resolution of fever, leukocytosis, and the abscess cavity in 8 patients. In 5 of these, definitive cure was achieved with percutaneous drainage. In 3, single-stage bowel surgery and fistulectomy were performed following resolution of the abscess cavities and improvement of clinical signs and symptoms. All patients had uncomplicated postoperative courses. Percutaneous drainage should be the initial drainage procedure in treating postoperative abscesses, and, when performed preoperatively, can diminish surgical morbidity.     

The sacral hiatus approach for drainage of anterior lumbo-sacral epidural abscesses. A case report and technical note

Lumbosacral epidural abscesses are managed either conservatively with IV antibiotics or with open surgery, particularly in the presence of acute neurological symptoms. Their location makes it difficult for image-guided interventional approaches either for biopsy or evacuation. We report the sacral hiatus and canal as a corridor for image-guided minimally invasive abscess of lumbosacral epidural abscess for aspiration. A 56-year-old man presented to the emergency department complaining of six weeks of worsening low back pain. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as an anterior epidural abscess extending from L4-5 disc space to the S2 vertebral level. Blood cultures grew out gram-positive cocci. For drainage, a 5-French micropuncture kit was utilized to access the hiatus. Under fluoroscopic guidance a microwire was then advanced along the sacral canal. An 18-gauge needle curved to approximate the contours of the sacral canal was then advanced over the guidewire. Once anatomic access was established 2 ml of thick purulent material was aspirated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image-guided aspiration of lumbosacral epidural abscesses can thus be carried out in a safe and effective manner using a sacral hiatus approach.     

Ultrasound-guided drainage of deep pelvic abscesses: experience with 33 cases

The aim of this study was to demonstrate and evaluate the ultrasound-guided drainage of deep pelvic abscesses in which transabdominal percutaneous access could not be performed because of overlying structures. A retrospective analysis of 32 consecutive patients with 33 deep pelvic abscesses was performed. The underlying causes of the abscesses included postsurgical fluid collection or surgical complications in 18 of the 32 patients, and 11 of these patients underwent recent rectal cancer surgery. The locations of the abscesses, which had a median diameter of 6 cm (range 2-10 cm), were as follows: perirectal (n = 13), presacral (n = 9), pouch of Douglas (n = 7), internal genitals (n = 2) and between the bowel loops (n = 2). The abscesses were all drained using ultrasound (US) guidance with a transrectal (n = 18), transvaginal (n = 11), transperineal (n = 2) or transgluteal (n = 2) approach. Of the larger abscesses (median diameter 7 cm), 19 were treated with catheter drainage and 18 of these cases resulted in favorable clinical outcomes. Of the smaller abscesses (median diameter 4 cm), 14 were treated with needle drainage. In two of these cases, follow-up US showed that a repeat puncture and drainage was necessary. All needle drainages resulted in favorable clinical outcomes. Sixteen of the 29 transrectal or transvaginal drainage procedures were performed without any anesthesia (10 were performed with a needle and six were performed with a catheter). Apart from minor discomfort during the drainage procedure and the subsequent in-dwelling catheter period, there were no serious complications related to the drainage procedures. We conclude that ultrasound-guided transrectal, transvaginal, transperineal and transgluteal drainage of deep pelvic abscesses are safe and effective treatment approaches. Based on our findings, needle drainage will be our most common first-line treatment approach because of the simplicity of the procedure, improved patient comfort and reduced costs. Catheter drainage will be reserved for large multiloculated abscesses.(E-mail: tlo@dadlnet.dk)     

超声引导下置管引流与穿刺抽吸在肝脓肿治疗中的比较

目的:比较超声引导下穿刺抽吸与置管引流在肝脓肿治疗中优劣。方法:33例置管引流与87例穿刺抽吸两组患者,术后比较体温及白细胞下降至正常的时间,平均住院时间以及并发症。两种方法均同时采用静脉内给抗生素治疗。结果:两组方法在疗效及安全性上无显著差异(包括体温及白细胞降至正常时间,平均住院时间以及并发症)。结论:超声引导下穿刺抽吸或置管引流在治疗肝脓肿的疗效与安全性均无显著差异。     

前列腺癌经直肠超声声像特征

本文分析了172例可疑前列腺癌者经腔内超声及其引导下穿刺活检确诊的49例前列腺癌的声像学特征。认为前列腺癌除了主要表现为低回声型特点外,尚可出现其它回声类型改变及一些间接征象。前列腺介入性超声及其指引下的穿刺活检是前列腺癌诊断及疗效随访的主要方法。     

经直肠超声在前列腺囊肿诊断中的价值

目的探讨经直肠超声前列腺检查对前列腺囊肿的早期诊断价值。方法全部病例均行经腹超声(TAS)及经直肠超声(TRUS)对比检查。结果110例前列腺疾患者,TAS检出7例(6%)前列腺囊肿,TRUS检出24例(22%)前列腺囊肿,两种方法的检出率及不同年龄组的患病率有明显差异。结论TRUS对前列腺囊肿的探测敏感性高于TAS,而且可进一步帮助定性诊断,是诊断前列腺囊肿的理想方法。     

经直肠能量多普勒超声在前列腺穿刺活检中的临床价值

目的：探讨经直肠能量多普勒超声（PDU）在前列腺穿刺活检中的临床应用价值,提高前列腺癌的诊断率。方法：对临床高度怀疑前列腺癌的54例病人在穿刺前完成经直肠二维灰阶超声的常规检查、PDU检查,根据检查结果选择经直肠二维灰阶超声、PDU及两者联合使用靶向穿刺结合6点前列腺系统穿刺活检方案。对比分析直肠二维灰阶超声、PDU靶向穿刺活检诊断前列腺癌的敏感性、特异性、阳性预测值、阴性预测值。结果：经直肠PDU检查发现异常血流增多37例,其中前列腺癌23例（包括2例为灰阶超声无异常发现的位于外腺的前列腺癌）,前列腺增生症11例,前列腺癌不能除外1例, 前列腺占位1例（未定）,转移性前列腺癌1例（膀胱癌）。结论：经直肠PDU能提高前列腺癌检测的敏感性与定位适合穿刺点,经直肠PDU靶向穿刺活检病理Gleason评分更高。     

New trends in the management of peritonsillar abscess

Peritonsillar abscess is the most common complication of acute tonsillitis. Signs and symptoms include fever, unilateral sore throat, odynophagia and trismus. Optimal management consists of antibiotic therapy and drainage of the abscess. Controversy exists about the drainage procedure, which includes needle aspiration, incision and drainage, or acute tonsillectomy. Data indicate that outpatient needle aspiration, antibiotics and pain medication are effective treatment in 85 to 90 percent of patients with uncomplicated peritonsillar abscesses.     

经腹联合经直肠超声在前列腺中线囊肿诊断中的应用

目的探讨经腹超声(TAS)联合经直肠超声(TRUS)对前列腺中线囊肿的诊断价值。方法根据检查方法将71例前列腺中线囊肿患者的资料分成两组,TRUS探查为对照组(30例),TAS+TRUS联合探查为观察组(41例),均经穿刺或病理证实,回顾分析并对比两组诊断符合率。结果观察组对是否与精道相通、伴随征象及并发症的检出能力高于对照组,两组的超声诊断符合率差异有统计学意义(P﹤0.05)。结论 TAS+TRUS联合探查较单纯使用TRUS在前列腺中线囊肿诊断时更加准确、全面。     

经直肠超声及其穿刺活检对前列腺增生与前列腺癌的鉴别诊断价值

目的 评价经直肠超声检查及其穿刺活检对鉴别前列腺增生症与前列腺癌的价值。方法 将40例前列腺疾病患者术后病理分组，与术前经直肠超声检查声像图以及13例穿刺活检结果对照分析。结果 术后前列腺增生组27例，前列腺增生伴炎症组4例，前列腺癌组9例，术前经直肠超声检查诊断前列腺增生27例，疑诊前列腺癌13例并行穿刺活检，其中6例术前穿刺确诊为前列腺癌，3例前列腺癌未穿刺，但术后病理证实，经直肠前列腺癌超声诊断敏感性66．7％，特异性77．4％，准确性75％；而本组穿刺活检对前列腺癌选择性检出率为46．2％，其准确性、敏感性、特异性均为100％。结论 经直肠二维及彩色多普勒超声检查对于鉴别良性前列腺增生症与前列腺癌有着重要价值，可以选择性提高穿刺活检中前列腺癌的检出率，而结合经直肠超声检查的前列腺穿刺活检术则是发现并确诊前列腺癌的有效方法。     

Prostatic abscess in young males: a rare complication of Crohn's disease

We report a rare case of prostatic abscess with Crohn's disease in a 21-year-old male. Computed tomography showed a typical prostatic abscess. Moreover, filling of the abscess cavities with contrast medium was demonstrated after micturition, which represented the rupturing of the abscess into the urethra. Crohn's disease should be included in the differential diagnosis of prostatic abscesses even in young males.     

经直肠超声引导前列腺穿刺并发直肠大出血及其处理

目的　探讨经直肠超声 (transrectal ultrasound,TRUS)引导前列腺穿刺活检引起的直肠大出血及其处理方法。方法　回顾性总结 10 96例次 TRUS引导前列腺穿刺活检引起的 11例直肠大出血的临床资料。结果　在 11例患者中 ,前列腺癌 (prostatic carcinoma,PCA) 5例 ,良性前列腺增生 (benign prostatic hyperplasia,BPH) 4例 ,前列腺上皮内肿瘤 (prostatic intraepithelial neoplasm ,PIN) 1例 ,前列腺炎 1例 ;7例直肠大出血自行停止 ,4例出血不止 ,并出现生命体征异常 ,需要局部止血和输血。结论　尽管 TRUS引导前列腺穿刺活检可能引起多种并发症 ,但一般不需处理 ,即便并发直肠大出血也能有效地治疗 ,因此 ,它仍然是诊断前列腺癌的可靠方法。