Search

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。

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。

Clinical Effectiveness of Sphincter Preservation Method of Improved Minimally Invasive Surgery to Primary Cure for Horseshoe-Shaped Perianal Abscess

ObjectiveTo evaluate clinical curative effect of sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess. MethodsOne hundred and twenty hospitalized patients diagnosed as horseshoe-shaped perianal abscess were analyzed by prospective, random, single-blind, parallel-group design method, and were randomly divided into two groups, one group of sphincter preservation method of improved minimally invasive surgery (observation group), another group of traditional method of hanging line drainage and multiple incisions of radian shape (control group). The cure rate, long-term recurrence, postoperative pain score within 9 d, hospitalization time, incision healing time, scar area after healing, postoperative anal function score and perioperative and long-term complications were compared in these two groups. ResultsAll the operations were successfully completed in these two groups. There were 56 cases of primary healing in the observation group and 55 cases of primary healing in the control group. Compared with the control group, the postoperative pain score on day 2-4 or on day 7-9 was lower (P < 0.05), the incision healing time was shorter (P < 0.05), and the postoperative anal function score was lower (P < 0.05) in the observation group. There was no incision infection and hemorrhoea in these two groups. The hospitalization time, scar area after healing, incidence rate of urinary retention, hepatic and renal dysfunction, and the total white blood cells > 10.0×109/L had no significant differences between these two groups (P > 0.05). There was no long-term recurrence, anal stenosis, and anal incontinence during following-up of 6 months in these two groups. ConclusionPreliminary research results show that sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess has a reliable clinical curative effect, fast healing, and less postoperative complications.

Treatment of Liver Abscess Associated with Biliary Tract (Report of 12 Cases)

目的　探讨胆源性肝脓肿的诊治方法。方法　对我院2000~2004年期间收治并确诊为胆源性肝脓肿的12例患者进行分析，在应用抗生素和全身支持的前提下，再依据其病变发生、发展的不同阶段采用不同手段治疗。结果　4例急性期患者中2例行急诊胆道引流手术后治愈，另2例转为亚急性期（脓肿融合期）； 6例亚急性期患者均经B超导向下行脓肿穿刺抽脓后注入抗生素治疗后治愈； 4例慢性期患者行脓肿切开引流后治愈。结论　本病在应用广谱抗生素（二联抗生素）和全身支持治疗的前提下，再根据病变不同时期采用不同方法治疗，可获得良好效果。

副肿瘤性天疱疮伴Castleman瘤患者肛周脓肿护理一例

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。

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。

The clinical effect of VSD technology in the treatment of high perianal abscess

Objective To evaluate the clinical effect of vacuum sealing drainage (VSD) technology in the treatment of high perianal abscess. Methods A total of 38 cases of high perianal abscess who underwent surgery in our hospital from May. 2014 to Feb. 2016 were randomly divided into 2 groups: the VSD group (n=19) and the control group (n=19). The cases of VSD group were performed with closure of internal orifice+VSD technique, and the cases of control group were treated with radical operation of perianal abscess (low incision combined with high thread operation). The following indexes of cases in 2 groups were compared and analyzed, including postoperative pain score, wound healing time, postoperative anal function score, and prognosis. Results There were significant differences in pain score (3.53±0.70vs. 5.11±0.74), postoperative anal function score (0vs. 1), and wound healing time〔(27.58±4.95) dvs. (44.68±6.53) d〕between VSD group and control group,P<0.05. Compared with the control group, the pain score and anal function score of the VSD group were both lower, and the wound healing time was shorter. However, there was no statistically significant difference in incidence of fistula between the two groups〔5.3% (1/19)vs. 15.8% (3/19),P=0.60〕. Conclusion In the treatment of high perianal abscess, VSD technology can relieve pain in patients, shorten the wound healing time, protect the anal function, and the prognosis is as well as low incision combined with high thread operation, so VSD is a better treatment method for high perianal abscess.

大型“C”臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿的临床观察

目的探讨大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿的疗效。 方法将12例肺脓肿患者随机分为治疗组和对照组, 每组各6例。对照组患者予以止咳、化痰、抗感染及体位引流等常规治疗。治疗组患者在上述治疗的基础上加用大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗。两组患者的疗程均为3周。 结果对照组患者的总有效率为68.8%;治疗组患者的总有效率为100.0%, 两组总有效率比较差异有统计学意义(P＜0.05)。治疗组患者的住院时间、抗生素应用时间及血降钙素原恢复正常时间均较对照组明显缩短(P＜0.05)。治疗组电子支气管镜治疗过程中未出现严重并发症。 结论大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿具有疗效确切、治愈率高、疗程短的特点。

Exploration of clinical pathway for perianal day surgery based on enhanced recovery after surgery concept

Objective To explore the application effect of the clinical pathway for perianal day surgery based on enhanced recovery after surgery (ERAS) concept. Methods The case data of patients who underwent perianal surgery in the Department of Anorectal Surgery of Gansu Provincial Hospital between January and October 2023 and patients who underwent perianal day surgery based on the ERAS clinical pathway in the Ambulatory Surgery & Chemotherapy Centre of Gansu Provincial Hospital were retrospectively collected. The patients in the Department of Anorectal Surgery were defined as the control group, while the patients in the Ambulatory Surgery & Chemotherapy Centre were defined as the pathway group. The differences in indicators such as hospitalization cost, average hospitalization time, preoperative hospitalization time, surgical time, intraoperative bleeding, patient satisfaction, and postoperative follow-up between the two groups of patients were analyzed. Results A total of 400 patients were included, with 200 in each group. The differences between the two groups in gender and age were not statistically significant (P>0.05), the Visual Analogue Scale of the pathway group was lower than that of the control group (P<0.05), and the Kolcaba Comfort Scale score was higher than that of the control group (P<0.05). The hospitalization cost, average hospitalization time, preoperative hospitalization time, and surgical time of the pathway group were all lower than those of the control group (P<0.05), and there was no statistically significant difference in intraoperative bleeding between the two groups (P>0.05). The satisfaction rates of the pathway group and the control group were 90.5% and 86.0%, respectively, and there was no statistically significant difference between the two groups (P>0.05). The follow-up results showed that perianal day surgery did not increase the discomfort of patients after discharge. Conclusions The clinical pathway for day surgery based on ERAS concept is more conducive to the postoperative recovery of patients undergoing day surgery, reducing medical costs, improving medical quality, and increasing patient satisfaction. It is worthy of clinical promotion and application.