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EnCor 真空旋切加双套管负压引流治疗乳腺脓肿

目的 探讨高频超声引导下 EnCor 真空旋切加双套管负压引流治疗乳腺脓肿的可行性及其临床应用价值。 方法 回顾性分析 2012 年 10 月至 2015 年 10 月期间于南京医科大学附属淮安第一医院治疗的 41 例乳腺脓肿患者的临床病理资料，其中有 20 例行 EnCor 真空旋切加双套管负压引流术（EnCor 组），21 例行常规切开引流术（对照组），比较 2 组患者疗效的差异。 结果 2 组患者在年龄、脓肿直径、脓肿位置等一般资料比较差异无统计学意义（P>0.05）。2 组患者手术治疗顺利，但 EnCor 组中有 2 例在旋切过程中发生出血，局部加压 1 h 后成功完成真空旋切术。2 组的手术时间比较差异无统计学意义（P>0.05）。EnCor 组的切口瘢痕大小、治愈时间、住院时间、换药次数及疼痛评分均明显优于对照组（P<0.05）。所有患者术后均治愈出院，无一例再手术，无术后出血、皮肤损伤、乳糜漏等并发症发生。41 例患者术后随访 3～20 个月，平均 12 个月，无一例失访。查体结合高频超声检查无脓腔残留及复发征象。对照组切口疤痕较明显，有1 例发生乳房变形；而 EnCor 组切口瘢痕微小，患者对术后乳房外形及治疗效果均满意。 结论 本研究的初步结果提示，EnCor 真空旋切辅以双套管负压引流治疗乳腺脓肿安全、可靠、痛苦小且微创。

改良前庭大腺囊肿及脓肿造口术的效果观察

目的探讨改良前庭大腺囊肿及脓肿造口术的临床效果。 方法选择2008年2月－2012年1月收治的前庭大腺囊肿及脓肿患者共50例，其中囊肿35例，脓肿15例。将患者按照其意愿分为2组，研究组27例行改良前庭大腺囊肿及脓肿造口术；对照组23例行常规的前庭大腺囊肿、脓肿造口术，观察两组手术时间、术中出血及术后的复发情况。 结果研究组手术时间为（9±4）min，对照组为（16±3）min，差异有统计学意义（t=6.676，P＜0.001）；研究组出血量为（3±2）mL，对照组为（10±3）mL，差异有统计学意义（t=9.835，P＜0.001）；研究组术后1例复发，复发率为3.7%；对照组7例复发，复发率为30.7%，两组差异有统计学意义（χ2=4.764，P=0.029）。 结论改良前庭大腺囊肿及脓肿造口术，手术方法简便，手术时间短，出血少，患者术中、术后痛苦小，术后愈合好，保留了前庭大腺的功能，对性生活无影响，患者依从性好，术后复发率低，值得临床推广。

Diagnosis and Treatment of Splenic Abscess Report of 11 Cases

【摘要】目的探讨脾脓肿的易感因素、诊断与治疗。方法对1990年6月至2002年8月收治的11例脾脓肿患者资料进行回顾性分析。结果11例患者中8例行手术或穿刺治疗，3例保守治疗。10例患者治愈或好转出院，1例保守治疗无效死于败血症。结论加强对脾脓肿的认识是提高本病早期诊断的关键，脾切除是治疗脾脓肿的首选方式。

心包脓肿破溃致急性脓胸诊治一例

继发性纵隔脓肿的诊断与治疗

目的 探讨多种原因导致的继发性纵隔脓肿的诊断和综合治疗方法。 方法 回顾性分析1988年12月至2007年11月中国医科大学附属第一医院收治的23例继发性纵隔脓肿的临床资料，男18例，女5例；年龄13个月～76岁，平均年龄40.9岁。致病原因：食管穿孔或破裂14例（外伤致食管破裂7例、医源性食管破裂6例、自发性食管破裂1例），咽部脓肿5例，口底蜂窝组织炎2例，气管断裂2例。采取以外科手术治疗为主，辅以抗感染和营养支持治疗。行食管破裂修补术10例次，空肠或胃造瘘术6例次，脓胸纤维板剥脱术4例次，经颈部切口上纵隔引流术15例次，胸腔闭式引流术7例次，肺叶部分切除术2例次，心包引流术1例次，牙周和颌下切开引流术1例次。 结果 住院死亡5例，病死率21.7%（5/23），死于中毒性休克4例，静脉大出血1例。出院时完全治愈或病情稳定18例。随访16例，随访时间6～18个月，随访期间生存患者生活质量提高，死于脑血管意外1例；失访2例。 结论 继发性纵隔脓肿病情发展迅速，且病死率高，应早期诊断，充分的外科引流、合理使用抗生素和营养支持是治疗的关键。

RUPTURE OF LIVER ABSCESS:ANALYSIS OF 77 CASES

Rupture is one of main complications of liver abscess. Seventy-seven patients with rupture of liver abscess are reviewed. Liver abscess may freely rupture into adjacent structures or organs or serous cavities and cause vatious complications. The causative factors of rupture of liver abscess in this series were late medical consultation in the course of the disease, delayed treatment due to misdiagnosis, and improper treatment. Measures that prevent rupture of liver abscess include raising clinical awareness of early diagnosis and timely effective drainage. The authors consider that transperitoneal surgical drainage is the best approach. Most patients with rupture of liver abscess should be treated by surgical drainage togather with transomental or transumbilital veno-catheterization for antibiotic infusion. Patients with rupture of liver abscess usually present a poor prognosis and a high mortality rate. The mortality in this group was 35.1%(27/77), which is closely related to the complications of the rupture of liver abscess.

Percutaneous Catheter Drainage Versus Needle Aspiration in Management of Bacterial Liver Abscess

Objective　To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods　The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results　There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and 　(19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions　PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.

Pulmonary abscess caused by Rhodococcus equi : a case report and literature review

ObjectiveTo examine the characteristics of Rhodococcus equi (R. equi) infection for better awareness of this disease.MethodsThe clinical data of a patient with pulmonary abscess caused by R. equi after renal transplantation were reported. We also reviewed the reports of infections caused by R. equi.ResultsThe clinical manifestations and laboratory examination of the patient were consistent with the characteristics of R. equi infection. The growth of R. equi was found in sputum and blood culture. The follow-up data showed that the treatment was effective. Literature search identified 23 similar patients. In all the 24 patients (containing this one), the time of infection after renal transplantation ranged from 4 months to 11 years. There were 21 patients with cumulative pulmonary infection, and 10 patients had a clear epidemiological history of direct or indirect contact with horses. Eighteen patients improved after regular antibacterial treatment or surgical treatment.ConclusionsOpportunistic infections caused by R. equi mainly affect transplant recipients and other patients with lower immunity. Infections caused by R. equi may affect many organ systems with various manifestations. The optimal therapy is not established due to the rarity of this infection. Clinicians should select antibiotic agents rationally based on antimicrobial susceptibility testing and treatment response of patients.

非免疫缺陷患者确诊为纵隔黄曲霉脓肿一例报道并文献复习

目的 总结分析纵隔曲霉病的临床特征，以提高临床医生对纵隔曲霉病的认识。方法 回顾性分析1例纵隔黄曲霉脓肿患者的临床资料、实验室检查、影像学检查、治疗方案及预后，并复习国内外相关文献。结果 患者男，68岁，其胸部CT示纵隔肿块，伴气管、右主支气管复杂狭窄，纤维支气管镜及经超声支气管镜针吸活检（endobronchial ultrasound-guided transbronchial needle aspiration，EBUS-TBNA）及宏基因组二代测序（metagenomic next-generation sequencing，mNGS）诊断为纵隔黄曲霉脓肿。予伏立康唑及激素治疗后病情好转，4个月后随访患者病情稳定。以“纵隔曲霉病、纵隔脓肿”与“非免疫缺陷者”为关键词检索中国知网医学数据库和维普网数据库，国内尚无文献报道。使用“mediastinal aspergillosis”、“aspergillus mediastinitis”、“mediastinal aspergilloma”检索PubMed数据库中的英文文献，共检索到文献17篇，均为个案报道。结论 非免疫缺陷患者出现纵隔肿物时，需警惕曲霉感染的可能，早期及时的诊断及治疗尤为重要。EBUS-TBNA联合mNGS可作为纵隔曲霉病的诊断方法之一。伏立康唑联合小剂量激素（0.5 mg/kg）治疗方案，可能为纵隔曲霉病提供新的治疗思路。

2型糖尿病患者发生颈深部脓肿的原因分析及护理

目的探讨2型糖尿病患者发生颈深部脓肿的原因、治疗及护理方法。 方法对2012年1月-2013年8月收治的12例2型糖尿病合并颈深部脓肿患者的临床资料进行回顾性分析，分析其发生颈深部脓肿的原因，并进行治疗和护理。 结果高血糖、年龄大、口腔卫生差是主要原因。12例2型糖尿病合并颈深部脓肿的患者通过脓肿切开引流术，结合抗菌药物、胰岛素的合理使用以及有力的营养支持等综合治疗和精心的护理，全部治愈出院。 结论2型糖尿病患者发生颈深部脓肿应及时寻找原因，给予恰当的切开引流、伤口换药等治疗，还应注意合理使用抗菌药物控制感染及胰岛素控制血糖。精心的护理是减少并发症、促进患者康复的重要因素。