改良双腔气囊管引流治疗肝脓肿

肝脓肿是外科常见的感染性疾病,手术引流是治疗肝脓肿的基本方法之一。我院自1990年6月以来应用改良双腔气囊管治疗肝脓肿,效果满意,现报告如下。临床资料1.一般资料:116例肝脓肿患者随机分为A、B两组。A组(应用双腔气囊管引流组)65例,男46例,女19例,年龄为8~72岁;细菌性55例,阿米巴性3例,混合性6例,晚期肝癌伴感染1例;脓腔大小4~15.5 cm;脓肿位于肝左叶者21例,肝右叶者32例,两叶均有者12例;病程1~164 d。B组(对照组)51例,为普通橡皮管作引流者,其中男39例,女12例;细菌性45例,阿米巴性2例,混合性4例;脓腔大小3.5~14.5 cm;脓肿位于肝左叶者…     

克罗恩病合并腹腔脓肿的治疗体会

目的 探讨克罗恩病合并腹腔脓肿的外科治疗策略.方法 回顾性分析2000年1月至2012年6月收治克罗恩病合并腹腔脓肿患者13例的临床资料.结果 仅经皮穿刺引流(PAD)治疗2例,仅行手术治疗5例,PAD治疗后择期手术者3例,PAD治疗后使用英夫利西单抗治愈而无需手术治疗3例.结论 合理的个体化综合治疗是治疗克罗恩病合并腹腔脓肿的最佳选择.     

微创经皮肾镜取石术后发热的处理和预防

目的：总结微创经皮肾镜取石术后发热的诊治体会。方法：回顾性分析2006年3～8月微创经皮肾镜取石术后78例发热患者的临床资料。66例采用单纯抗生素对症治疗,12例采取相应的外科处理,其中调整肾造瘘管或双J管位置7例,输尿管镜取石2例,胸腔闭式引流2例,腹腔引流1例。结果：所有患者发热均得到有效控制。结论：微创经皮肾镜取石术后最常见的并发症是发热,合理使用抗生素是最主要的处理和预防措施;相应的外科处理对部分患者是必需的。     

切开引流加挂线术治疗肛管直肠周围脓肿104例报告

肛管直肠周围脓肿是普外科的常见疾病之一 ,通常的治疗方法为单纯脓肿切开引流术 ,但术后肛瘘及脓肿再发的发生率较高 ,给病人带来 2次手术的痛苦。我们应用 1期脓肿切开引流术加挂线术处理急性肛管直肠周围脓肿 ,使绝大多数患者伤口愈合后无肛瘘形成和脓肿再发。现将我院1986年 1月至 1996年 12月 ,有随访资料的急性肛管直肠周围脓肿 10 4例 ,采用单纯切开引流术和 1期切开引流加挂线术治疗的结果报道如下。一、资料和方法全组患者 10 4例 ,男 85例 ,女 19例 ,年龄 14～ 73岁 ,平均年龄 38 2岁 ,35岁以下者 82例 ,占 79 8% ;单纯切开引流组…     

介入超声穿刺引流治疗胰周脓肿

目的 探讨采用介入超声技术行胰周脓肿引流的可行性.方法 回顾性分析2006年7月至2009年11月成都军区总医院收治的36例胰周脓肿患者的临床资料.结合胰周脓肿的部位、范围、形状等因素,确定穿刺点位置.根据穿刺点与靶区的空间对应关系,计算导管针进入的角度和方向,在超声引导下置入引流管引流.结果 36例患者均成功接受穿刺引流,33例治愈,治愈率为92%,平均治愈时间37 d.3例因穿刺引流效果欠佳改行开腹手术引流.3例患者并发肠外瘘,经非手术治疗痊愈.所有患者随访3～48个月,无脓肿残留或复发.2例并发1型糖尿病,1例消化不良,2例合并胆囊结石,经对症治疗痊愈.27例患者体质量较术前增加.结论 介入超声穿刺引流治疗胰周脓肿切实可行.     

介入超声穿刺引流治疗胰周脓肿

目的 探讨采用介入超声技术行胰周脓肿引流的可行性.方法 回顾性分析2006年7月至2009年11月成都军区总医院收治的36例胰周脓肿患者的临床资料.结合胰周脓肿的部位、范围、形状等因素,确定穿刺点位置.根据穿刺点与靶区的空间对应关系,计算导管针进入的角度和方向,在超声引导下置入引流管引流.结果 36例患者均成功接受穿刺引流,33例治愈,治愈率为92%,平均治愈时间37 d.3例因穿刺引流效果欠佳改行开腹手术引流.3例患者并发肠外瘘,经非手术治疗痊愈.所有患者随访3～48个月,无脓肿残留或复发.2例并发1型糖尿病,1例消化不良,2例合并胆囊结石,经对症治疗痊愈.27例患者体质量较术前增加.结论 介入超声穿刺引流治疗胰周脓肿切实可行.     

胰腺脓肿分型及治疗方法的探讨

近年来 ,重症急性胰腺炎 (SAP)的早期死亡率已经明显降低 ,胰腺脓肿等中晚期并发症的处理越来越重要。我科近 2 0年来共收治 4 8例胰腺脓肿 ,分别采用剖腹引流、经皮穿刺置管引流、低位小切口不经腹引流和F管引流四种方法治疗 ,现报告如下。1.临床资料 :本组均为SAP后胰腺脓肿 ,男 2 2例 ,女 2 6例 ,年龄 2 6～ 78岁。经积极治疗顺利地渡过急性反应期进入感染期 ,此期平均在起病后 4～ 6周 ,病人出现感染的症状和体征 ,经B超或 (和 )CT证实为胰腺周围液体积聚或为蜂窝样改变。 4 8例胰腺脓肿全部采用外科引流并得到证实 ,其中 14例经二…     

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。     

B超引导下脓腔置管闭式引流治疗急性化脓性乳腺炎30例

探讨B超引导下脓腔置管闭式引流治疗急性化脓性乳腺炎的疗效。回顾性分析2013年8月—2015年4月B超引导下脓腔置管闭式引流治疗的30例急性化脓性乳腺炎患者的临床资料。30例患者均成功治愈,住院时间平均为5 d(3~10 d)。术后随访2周~6个月,均未出现脓肿复发及其他不适。B超引导下脓腔置管闭式引流治疗急性化脓性乳腺炎创伤小,恢复快     

A proposal of subcategorization of bacterial prostatitis: NIH category I and II diseases can be further subcategorized on analysis by therapeutic and immunological procedures

Aim: We propose preliminarily that acute (category I of the NIH consensus definition) and chronic prostatitis (category II) can be subcategorized into primary and recurrent diseases based on the precise analysis of the clinical course and the immunological parameters in prostatic secretions of our cases. Methods: Five patients with stone‐free, acute febrile prostatitis and nine patients with acute episodes of afebrile urinary infection were included. The expressed prostatic secretions (EPS) were collected soon after the acute illnesses subsided after medication administration and they were examined microscopically, bacteriologically, and serologically. First‐line medications were cefem antibiotics with conventional doses for febrile cases and low doses for afebrile cases. They were administered for at least 2 weeks. Second‐line conventional medication with sulfamethoxazole‐trimethoprim or levofloxacin was given only to the patients in whom remaining prostatic infections were revealed. Results: The first‐line medications were successful in all patients and they promptly became asymptomatic in 1 week. All the EPS were infected except for two afebrile cases. Prostatic infections were eradicated by second‐line conventional medications. In a patient with afebrile prostatitis whose EPS were free of macrophages and immunoglobulin (Ig)M, the eradication of prostatic pathogens was achieved without second‐line antibacterial medication. Conclusions: Bacterial prostatitis could be classified into primary and recurrent chronic infections in each of the febrile (category I) and afebrile (category II) illnesses. A cefem regimen in varying doses was a clue for differential diagnosis as it did not affect the pathogens in the prostatic ducts or acini unless heavy urine reflux occurred in the ductal draining systems. Macrophages and immunoglobulins, especially IgM, in the EPS were useful immunological parameters to differentiate primary and recurrent infections of the prostate. Fluoroquinolones or sulfamethoxazole‐trimethoprim should not be employed in acute urinary infections in male patients until the confirmation of prostatic infection to avoid injudicious use of them, which might cause an increasing prevalence of resistant uropathogens in the community. The evacuation of the prostate by repetitive massage seemed to be effective to enhance the prompt eradication of pathogens from the prostatic tissue and to keep patients asymptomatic throughout the course of the disease by preventing tissue pressure elevation.     

Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen

PURPOSE: Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance. MATERIALS AND METHODS: From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinary tract infection and PSA greater than 30 ng./ml., without a rectum or who refused biopsy were excluded from study. RESULTS: Of the 187 study patients 122 were evaluable with a mean PSA of 9.35 ng./ml., including 51 (42%) with laboratory signs of prostatitis. After treatment PSA was normal in 22 cases and remained elevated in 29, including 9 in which biopsy revealed cancer. The change or improvement in PSA was significantly greater in men with benign results than in those with prostate cancer (-21.32 versus -1.33%, p = 0.001). In the cohort with negative expressed prostatic secretion and VB3 results transrectal ultrasound guided biopsy was done promptly. Screening decreased the number of biopsies by 18% (22 of 122 cases). The positive predictive value of PSA for detecting biopsy proved cancer improved with screening for prostatitis (45 of 122 cases or 37% versus 36 of 71 or 51%). Long-term followup revealed continued normal or stable PSA in the prostatitis cohort. CONCLUSIONS: Screening for NIH category IV prostatitis should be considered in men with elevated PSA. Although patients may be asymptomatic, anxiety caused by prostate cancer and diagnostic procedures contributes to the clinical significance of this disorder.     

Classification and diagnosis of prostatitis: a gold standard?

The National Institutes of Health Classification System for prostatitis has now been accepted by the North American and International urology community. This categorization system consists of category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome - CP/CPPS) and category IV asymptomatic inflammatory prostatitis. The evaluation of a patient with category I and category II bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The clinical tests for the evaluation of CP/CPPS can be classified as mandatory, recommended and optional. Mandatory evaluations include history and physical examination, urinalysis and urine culture. Recommended evaluations include lower urinary tract localization tests, symptom index, flow rate, residual urine determination and urine cytology. Optional evaluations include semen analysis and culture, urethral swab, urodynamics, cystoscopy, imaging, and prostate specific antigen determination. The physician must individualize a rational diagnostic strategy for each patient. There is no 'gold standard' for the diagnosis and evaluation of patients presenting with prostatitis.     

Cases of bacillus Calmette-Guerin-induced granulomatous prostatitis and prostatic stromal invasion of the bladder carcinoma in situ, showing similar clinical findings

Intravesical instillation of bacillus Calmette-Guerin (BCG) is the first-line therapeutic option for flat carcinoma in situ (CIS) of the bladder. Intravesical BCG instillation has been demonstrated to cause granulomatous prostatitis. Bladder CIS often also is known to show prostatic stromal invasion. We report a case of BCG-induced granulomatous prostatitis and a case of prostatic stromal invasion of bladder CIS accompanied by locally advanced prostate cancer, which showed similar clinical findings after the intravesical BCG therapy. In these 2 patients, urinary symptoms such as dysuria were prolonged regardless of anti-tuberculous medication, hard nodules were palpable at the prostate, and hypoechoic lesions were visualized by transrectal ultrasound. Both patients were treated by transurethral resection of the prostate, and the diagnoses were made by histopathological examination. Urinary symptoms were resolved in both patients after surgery, but the prostatic stromal tumor showed recurrence of growth. We report the usefulness of transurethral resection of the prostate for medication-resistant BCG-induced granulomatous prostatitis, and the importance of the correct diagnosis of prostatic stromal invasion of bladder CIS especially in the cases with concurrent prostate cancer.     

桂林地区BPH并前列腺炎的发病及治疗情况调查

目的：调查前列腺增生（BPH）患者并发前列腺炎的发病及治疗情况。方法：对桂林地区2152例BPH患者询问病史,并作前列腺液常规、前列腺B超、血清前列腺特异抗原（PSA）及尿常规等检查。结果：2152例患者中只有385例患者存在前列腺炎,占17．9％,其中87例患者有较明显的前列腺炎症状,35例患者曾诊断为前列腺炎并进行过间断治疗。结论：目前对BPH患者并发前列腺炎的诊断及治疗均不理想,应引起临床医师的高度重视。     

Transrectal longitudinal ultrasonography of the prostate by electronic linear scanning (1)

Transrectal longitudinal ultrasonography of the prostate was done for 20 patients with prostatic diseases, 12 with benign prostatic hypertrophy, 6 with bladder neck contracture, and 2 with chronic prostatitis. The intravesical protrusion of the prostate and the opening of the bladder neck, which can be easily recognized by this method, were discussed in relation to dysuria, using subjective symptoms, residual urine, and uroflowmetry (peak flow rate) as parameters. The former was slightly correlated to dysuria, and the latter was definitely correlated to dysuria.     

Nonspecific granulomatous prostatitis.

Nonspecific granulomatous prostatitis is a relatively rare disorder of the prostate. We encountered 4 cases of this type of chronic inflammation, including 1 case of xanthogranulomatous prostatitis. In all cases the diagnosis was made by histologic examination of specimens obtained by transurethral resection, retropubic prostatectomy, or transrectal needle biopsy. Echography revealed a hypoechoic lesion in the case of xanthogranulomatous prostatitis, while the other cases showed no specific findings except for the associated adenomas. The major symptoms were frequency and dysuria caused by urinary tract infection or benign prostatic hyperplasia associated with the granulomatous prostatitis.     

前列腺炎诊治中几个问题的探讨

目的提高前列腺炎的诊治水平。方法对近5年来临床工作中遇到的前列腺炎漏诊、误诊及认识有误的病例进行分析、探讨。结果有12例急性前列腺炎被误诊、漏诊，其中5例误诊为上呼吸道感染，7例诊断为尿路感染。15例前列腺增生（BPH）伴慢性前列腺炎者，漏诊了前列腺炎。17例慢性前列腺炎伴有其它泌尿生殖系疾病者，漏诊了其中之一。15例前列腺液常规中白细胞数与前列腺炎严重程度及治疗效果不一致。4例B超检查提示前列腺炎，患者无不适，按前列腺炎治疗后反而出现症状。结论前列腺炎诊治中尚存在一些问题。临床工作中需开阔思路，多做肛指检查。对症状、体征、前列腺液检查、B超检查结果等进行综合考虑，才能作出正确的诊断和治疗。     

Prostatitis and its Management

Classification of Prostatitis SyndromeThe diagnosis of symptomatic prostatitis refers to a variety of entities which may be related to infection and inflammation of the prostate gland (bacterial prostatitis), inflammatory and non-inflammatory chronic pelvic pain syndrome, and pelvic pain not related to prostatitis.Clinical DiagnosticsIn acute bacterial prostatitis, clinical symptoms are typical. Infection is defined by midstream urine analysis. In CBP, the key point of diagnosis is the use of a 2-glass test, with or without additional ejaculate analysis. The same test is used to define or exclude inflammation and / or infection in CPPS. In CPPS, symptomatic evaluation is based on a validated NIH-CPSI questionnaire. Additional phenotyping may be helpful in characterizing the predominant symptoms.TherapyAntibiotics surely play a fundamental role in bacterial prostatitis therapy. They should be introduced empirically in acute prostatitis with a high intravenous dose and always guided by resistance determination in chronic cases. Thanks to their pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones remain the most highly recommended antibiotics. The most appropriate treatment for chronic pelvic pain syndrome is a multimodal approach based on phenotyping including alpha-blockers, antibiotics, anti-inflammatory medication, hormonal therapy, phytotherapy, antispasmotics and non-drug-related strategies, such as psychotherapy and attempts to improve relaxation of the pelvic floor. The response can be evaluated by a drop in symptoms, using the scoring of the NIH-CPSI.     

伴有神经源性膀胱和前列腺憩室的前列腺巨大结石1例报告并文献复习

目的:探讨和总结伴有神经源性膀胱和前列腺憩室的前列腺巨大结石的病因、临床表现、诊断与治疗。方法:结合相关文献复习并回顾性分析1例伴有神经源性膀胱和前列腺憩室的前列腺巨大结石患者的临床资料。患者男,37岁,尿失禁22年,间断排尿困难伴尿频9年,加重3个月。既往有脊柱裂及耻骨上膀胱切开取石术病史。术前尿常规:WBC 17～20/HPF,RBC 12～15/HPF。腹部平片(KUB)+静脉尿路造影(IVU)及盆腔CT:隐性脊柱裂,神经源性膀胱,前列腺巨大结石。结果:患者行经尿道前列腺电切(TURP)+钬激光碎石术,结石成分为碳酸磷灰石。术后2周复查影像尿动力学:最大尿流率及残余尿量均明显好转。术后至今随访17个月,尿失禁较术前明显减轻,尿线粗。结论:前列腺憩室合并前列腺巨大结石非常罕见,而神经源性膀胱可能为其发病的一个因素。膀胱镜检查是准确的检查方法。对于年轻和需要保留性功能者可采取TURP联合钬激光碎石术,术中结合直肠指检尽量彻底清除结石,术后密切随访。