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。     

肝脓肿的诊断和治疗

目的探讨细菌性肝脓肿的诊断和治疗方法,总结治疗经验,提高治疗效果。方法回顾性分析2000年1月-2008年12月108例细菌性肝脓肿诊断和治疗方法的临床资料。男74例,女34例,年龄最小20岁,最大78岁。左肝脓肿21例,右肝脓肿75例,双侧肝脓肿12例。单个脓肿78例,多发脓肿30例。脓腔最大12cm,最小3cm。结果内科保守治疗15例,11例治愈,4例转外科手术治疗;CT指引下穿刺抽脓5例,B超引导下穿刺抽脓52例,穿刺次数1～4次,共治愈55例,2例转手术切开引流;外科切开引流治愈42例。结论多个散在性肝脓肿以内科治疗为主。单个肝脓肿直径大于6cm者,多需切开引流;小于6cm者可在CT或B超导引下穿刺抽脓治疗,尤其是在B超导引下穿刺抽脓治疗,操作简便,效果好,可作为肝脓肿直径在6cm以下者的首选治疗方法。     

介入性超声在肾感染疾病的检查和治疗中的作用

本文介绍了51例有急性肾感染疾患的病人经超声断层检查证实26例急性细菌性局灶性肾炎、15例肾脓肿和10例肾积脓。讨论了有关在超声断层指引下经皮肾穿刺在感染性肾疾患的诊断和治疗中意义。根据超声断层检查和经皮肾穿刺所获得的资料,可以得到迅速的诊断,制定与感染相适应的抗生素的治疗,如果有必要可以在超声断层指引下经皮肾穿刺放入引流导管来辅助治疗。连续的超声断层检查可了解疾病的变化情况,避免了病人接受过多的放射线检查和静脉内注射造影剂。     

冲洗、烧灼加网膜填塞治疗细菌性肝脓肿9例报告

我院自 1986～ 2 0 0 0年间 ,采用冲洗、烧灼加网膜填塞治疗细菌性肝脓肿 9例 ,取得短时、快捷 ,一次解决和治疗彻底的疗效。现报告如下。1　资料与方法本组男性 6例 ,女性 3例。年龄 2 5～ 5 6岁。其中 7例继发于胆道感染 ,2例病人继发于化脓性阑尾炎术后感染。9例病人均经手术治疗。病理证实为细菌性肝脓肿 ,细菌培养均为G-杆菌感染。脓肿位于肝右叶 7例 ,肝左叶 2例 ,脓肿均为单发 ,脓腔直径为 10～ 16cm ,均系黄白色稠脓。住院后常规使用广谱抗生素辅助治疗 1～ 2天后予以手术引流 ,术后持续使用抗生素 3～ 5天 ,术后 9天拆线。 9例病…     

细菌性肝脓肿的中西医结合诊断与治疗

目的：总结细菌性肝脓肿的诊治经验。方法：回顾性分析1994年－2001年我院收治的48例细菌性肝脓肿临床诊断与治疗的有关资料。服用中药及抗生素9例（18．7％），穿刺引流服用中药15例（31．3％），穿刺置管引流19例（39．5％），手术引流5例（10．4％）。结果：75％的病例来自胆道感染，47．9％的病例患有糖尿病。寒战发热、肝区疼痛及白细胞增高是本病的主要临床表现，全部病例治愈。结论：治疗细菌性肝脓肿需根据分期及部位而选择不同的治疗方法。     

骶前肿瘤手术27例临床分析

目的探讨骶前肿瘤的诊断及手术治疗方法及经验。方法骶前肿瘤患者27例,21例初发,6例为复发。均行肛指检查、CT和（／或）MRI作出诊断。肿瘤直径平均6．3（2．4～10．3）cm。单纯经腹手术2例,单纯经骶手术20例,经腹经骶联合手术5例。结果切口一期愈合21例。病理类型：皮样囊肿7例,表皮样囊肿6例,畸胎瘤4例（1例恶变）,平滑肌瘤3例,神经纤维瘤2例,脂肪瘤1例,感染形成脓肿3例,皮脂腺囊肿1例。所有患者均获随访,时间7～14个月。3例经骶手术复发,其中2例为皮样囊肿切除后引流不畅形成积液,再行手术切除引流治愈;1例畸胎瘤手术后复发,再行经骶切除后成功。1例感染形成的脓肿复发,经加强局部引流后愈合。结论骶前肿瘤诊断并不困难,CT等检查可指导手术方式。大多数肿瘤都可以采用经骶入路切除,手术后引流通畅是保障愈合的关键。     

细菌性肝脓肿的诊断与治疗（附52例报告）

目的　总结细菌性肝脓肿的诊治经验。方法　对 5 2例细菌性肝脓肿进行回顾性分析。结果　①胆总管梗阻和化脓性胆管炎是本病的主要病因。②寒战、高热、肝区疼痛及白细胞增高是本病的主要临床表现。③早期诊断 ,充分引流是治愈的关键。结论　①细菌性肝脓肿是常见病。②辅助检查首选B超。③剖腹探查 ,经腹腔引流是本病首选引流入路。     

21例胰腺脓肿的治疗

目的 探讨胰腺脓肿的外科治疗。方法 回顾性分析21例重症急性胰腺炎并发胰腺脓肿的临床治疗资料，脓肿数目1～7个，直径3．2～11．7cm，所有病人均经手术清除脓肿及胰腺坏死组织，并行引流及腹腔灌洗。结果 19例痊愈出院，2例合并多器官功能衰竭死亡，3例并发胰瘘，7例脓肿复发再次手术(其中1例行5次手术，2例行3次手术)。结论 胰腺脓肿是重症急性胰腺炎的严重并发症，明确诊断后应立即手术治疗，术中尽可能清除坏死组织并根据具体情况决定引流管的大小、数量及放置部位，保持充分有效的引流至关重要。     

236例阑尾周围脓肿治疗体会

目的探讨阑尾周围脓肿的治疗方法及效果。方法 2008-10—2015-10共收治阑尾周围脓肿236例,回顾分析患者的临床资料。结果本组非手术治愈48例,其中12例3个月后阑尾炎再次急性发作,经急诊阑尾切除术治愈。阑尾切除、脓肿引流治愈96例。单纯脓肿切开引流治愈92例,其中24例3个月后阑尾炎再次急性发作,经急诊阑尾切除术治愈。结论阑尾周围脓肿是急性阑尾炎常见的临床病理类型,若未及时诊断和处理,有可能发展成弥漫性腹膜炎、化脓性门静脉炎和感染性休克。应根据患者的临床表现及影像学检查结果选择个体化治疗方案。     

细菌性肝脓肿的诊断与治疗

目的 总结细菌性肝脓肿的诊治经验。方法 对５２例细菌性肝脓肿进行回顾性分析。结果 （地）胆总管梗阻和化脓性胆管炎是本病的主要病因。（２）寒战、高热、肝区疼痛及白细胞增高是本病的主要临床表现。（３）早期诊断,充分引流是治愈的关键。结论（１）细菌性肝脓肿是常见病。（２）辅助检查首选Ｂ超。（３）剖腹探查,经腹腔引流是本病首选引流入路。     

Acute diffuse bacterial nephritis in horse shoe kidney

Horseshoe kidney is a congenital malformation which predisposes the patient to severe urinary tract infections, due to pelvic ectasia which is inherent in the malrotation of the renal units. Acute bacterial nephritis is an evolutionary stage of the acute renal infection situated between acute pyelonephritis and renal abscess. It is only possible to carry out a differential diagnosis of these two bodies through the application of some imaging technique, as it is impossible to differentiate them from a clinical point of view. A CT contrast scan is the most sensitive and specific means of diagnosing acute bacterial nephritis, and is considered to be the most appropriate test method. The CT scan usually reveals circular or wedge-shaped cortical areas which become striated after contrast administration. Treatment is based on broad-spectrum antibiotherapy, which must be continued for a period of 3 to 6 weeks. We present a case of diffuse acute bacterial nephritis, occurring in a paediatric patient with a horseshoe kidney, which was successfully treated by means of a prolonged course of antibiotics.     

Acute focal bacterial nephritis and renal abscess associated with vesicoureteral reflux. Report of a case

We report the case of a child with acute focal bacterial nephritis and a renal abscess in the right kidney associated with bilateral vesicoureteral reflux. The patient was treated successfully with antibiotics and bilateral ureterocystoneostomy. Urine has remained sterile since the operation, but the affected kidney has developed progressive scarring. This case suggests that acute focal bacterial nephritis and a renal abscess may cause a small kidney, which looks like a hypoplastic kidney, associated with vesicoureteral reflux.     

Developmental aspect of renal suppurations. Apropos of 2 cases

The authors set out to differentiate between two types of renal parenchymal suppuration in the light of two personal cases treated recently - renal abscess and localized acute bacterial nephritis (LABN), which is perhaps no more than a preliminary stage in the formation of a renal abscess. Case 1 concerns a LABN, diagnosed by CT scan. The treatment was purely medical and monitoring scans show no anomalies. Case 2 was a gathered abscess, also diagnosed by CT scan, and treated by surgical drainage. The interest of the differentiation between these two types of suppuration is essentially therapeutic. Once gathered, the abscess must be drained surgically, whereas the LABN can be treated medically, with close supervision to ensure complete cure. The differential diagnosis between the two is mainly by scanner, with a study of the respective densities.     

Acute focal bacterial nephritis: report of four cases

Focal acute bacterial nephritis is a localized bacterial infection of the kidney presenting as an inflammatory mass not containing drainable pus. The further distinction between acute focal bacterial nephritis and other renal masses is aided by the appropriate use of renal sonography and computed tomography. We report 4 cases with this entity.     

Evolution of acute focal bacterial nephritis into a renal abscess

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation, which may represent a relatively early stage of renal abscess. The pathogenesis of AFBN is thought to be hematogenous infection or ascending infection from the lower urinary tract. For the majority of children, the pathogenesis may be related to ascending infection, because pre-existing malformative uropathy, especially vesicoureteral reflux (VUR), is common in pediatric patients. Few clinical reports have demonstrated the evolution of this condition into renal abscess in children. We report a girl with AFBN associated with VUR that evolved into a renal abscess despite appropriate intravenous antibiotic therapy. We undertook serial radiological observation of its evolution. It is important to differentiate AFBN from renal abscess because the management of the two entities may be different, and follow-up studies are indispensable to determine appropriate therapy.     

胰肾联合移植术后外科并发症的单中心临床分析

目的 对单中心胰肾联合移植术后外科并发症的发生及预后进行评价.方法 因糖尿病合并终末期肾病接受胰肾联合移植的患者共40例,统计患者术后发生的外科并发症以及再次手术治疗的并发症.结果 术后出现需要临床处理的严重血尿4例,其中1例经手术行供者十二指肠置管冲洗后止血,2例予持续膀胱冲洗后止血,1例供者十二指肠与膀胱吻合口小动脉出血,手术止血.4例患者出现腹腔内出血,3例为胰腺出血,1例为十二指肠肌层出血,均经手术止血.腹腔感染8例,1例死于多脏器功能衰竭,2例行脓肿穿刺引流后治愈,2例经手术清除脓肿,3例给予抗生素治疗后治愈.术后出现吻合口瘘1例,致胰腺切除.肠梗阻4例,予中药灌肠后治愈.肺部感染7例,均为细菌感染,其中1例合并真菌感染,经抗感染治疗后治愈.另出现伤口愈合不良5例,泌尿系感染2例.胰肾联合移植术后因外科并发症再手术者共10例(14次),再手术率为25%(10/40),主要包括血尿2例(4次手术),腹腔出血4例,腹腔感染2例(3次),胰腺静脉血栓形成、吻合口漏及胰瘘各1例.结论 胰肾联合移植术后外科并发症主要包括血尿、腹腔出血、腹腔感染等,是影响胰移植物短期存活率的重要因素.

Abstract：

Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation,which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor's duodenum and bladder anastomotic artery hemorrhage.Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis.Abdominal infection occurred in 8 cases: one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications (14 operations). The re-operation rate was 25 %, including 2 patients (4 operations) for hematuria, 4 patients for abdominal hemorrhage, 2 patients (3 operations) for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics with endstage renal disease, surgical complication is still affecting the pancreas and kidney grafts after transplantation.     

Urinary tract abnormalities in children with acute focal bacterial nephritis

OBJECTIVE: To review the presentation, methods of diagnosis, and incidence of concomitant urological abnormalities in children with acute focal bacterial nephritis (AFBN, also known as lobar nephronia, a severe nonliquefactive infection involving one or more renal lobules). PATIENTS AND METHODS: Sixteen children (age range 6 months to 9 years) diagnosed with AFBN over a 5-year period were retrospectively reviewed. Their age, gender, presenting symptoms, presence of urinary tract abnormalities, radiological imaging and treatment were assessed. RESULTS: All 16 children received intensive intravenous and oral antibiotics. Ten required intervention for predisposing conditions including vesico-ureteric reflux (four), bladder diverticulum (one), renal and peri-rectal abscess (two), ureteric or bladder calculi (two), and renal mass (one). In addition, three children had reflux not requiring surgery; one had multiple renal calyceal diverticula, one had Hinman syndrome and one had leukaemia. CONCLUSION: Acute focal bacterial nephritis is being diagnosed with increasing frequency through increasing awareness and advances in imaging modalities. Active urological evaluation is warranted because of the high incidence of urinary tract abnormalities. In addition to antibiotics, intervention was needed in most children in this series.     

人类免疫缺陷病毒感染伴肾病患者的临床病理分析

目的对行肾组织活检的人类免疫缺陷病毒(HIV)感染合并肾病患者进行病理分析。方法纳入2011年1月至2018年12月四川大学华西医院肾内科接受肾组织活检的HIV合并肾病患者,分析其病理特征、干预措施和预后等。结果共纳入9例患者,其中肾病综合征患者6例,急性肾功能损伤患者1例,慢性肾炎综合征患者2例。组织学诊断:肾小球微小病变患者3例,膜性肾病患者1例,塌陷型局灶节段性肾小球肾炎(FSGS)伴膜性肾病患者1例,FSGS非特异型(NOS)患者1例,急性间质性肾炎患者1例,Ig A肾病患者1例,糖尿病肾病患者1例。5例患者在肾组织活检时首诊HIV感染(其中塌陷型FSGS伴膜性肾病、糖尿病肾病、急性间质性肾炎各1例,2例为肾小球微小病变),其余4例在HIV感染确诊后的不同时期(均行抗逆转录病毒治疗)发病。并发症:糖尿病1例,梅毒感染1例,甲状腺功能减退2例,乙型肝炎病毒感染3例。随访情况:3例患者失访,6例患者随访期间未发生严重感染,其中2例仍有大量蛋白尿,其余4例患者血尿消失,肾功能恢复正常水平,复查尿蛋白定量显著减少至可疑阳性或24 h定量<300 mg/d。结论HIV感染者出现肾脏损伤的临床表现多样,可出现不同程度蛋白尿和(或)血尿,伴或不伴肾功能不全,病理类型不仅限于人类免疫缺陷病毒相关性肾病(HIVAN),可出现糖尿病肾病、肾小球轻微病变、膜性肾病、非塌陷型FSGS、急性间质性肾炎、Ig A肾病。肾组织活检有助于明确诊断。抗逆转录病毒治疗有效情况下,依据患者的病理诊断,有针对性地给予糖皮质激素及细胞毒药物,并加强随访,有助于改善患者预后。肾病患者应加强HIV筛查。     

Acute focal bacterial nephritis (acute lobar nephronia) report of two cases

Acute focal bacterial nephritis (AFBN) is one of the acute renal infections, its entity can be distinguished from other renal infections by the findings of sonography and computed tomography. There is no evidence of liquefaction in focal masses of AFBN in contrast to renal abscess. We present two cases with AFBN. The first case was a 52-year-old man with diabetes mellitus and benign prostatic hypertrophy. The second case was a 24-year-old woman with bilateral vesico-ureteral refluxes. Although their initial symptoms mimicked those of acute pyelonephritis, the findings of sonography and computed tomography revealed renal masses. They were treated with anti-microbial agents, and showed rapid improvement on both clinical symptoms and renal masses.     

坏疽穿孔性阑尾炎阑尾切除术后腹腔残余脓肿防治的体会

目的总结坏疽穿孔性阑尾炎阑锁阑尾切除术后发生腹腔残余脓肿(PAIAA)的原因及防治体会。方法对2003年-2006年7月共763例阑尾切除术,其中75例坏疽穿孔阑尾炎,术后5例发生腹腔残余脓肿的临床资料行回顾性分析。结果5例病例均治愈出院,3例经抗感染保守治疗脓肿逐渐吸收而愈,2例手术引流后治愈。结论坏疽穿孔阑尾炎术后易发生腹腔残余脓肿,术中术后的正确处理是可以减少阑尾术后腹腔残余脓肿的发生。