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題 名 | Psoas Abscess: A 10 Year Review=腰肌膿瘍:十年病例的臨床分析 |
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作 者 | 李原地; 李聰明; 蘇世強; 劉昌邦; 王蒼恩; | 書刊名 | 微免與感染雜誌 |
卷 期 | 32:1 1999.03[民88.03] |
頁 次 | 頁40-46 |
分類號 | 415.5 |
關鍵詞 | 腰肌膿瘍; Psoas muscle abscess; |
語 文 | 英文(English) |
中文摘要 | 腰肌膿瘍是臨床上少見而嚴重的疾病,發病過程緩慢且臨床表徵多變,因此常造 成診斷上的困難而導致治療延誤。本文是收集自1988年到1998年在本院確定診斷腰 肌膿瘍的病例加以分析,總共11位病例,原發性膿瘍有6個病例,病因不明,主 要的致病菌種是金黃葡萄球菌:續發性膿瘍有5個病例,與腎臟及泌尿系統疾病相 關。主要的症狀是發燒、畏寒、下背及腰脅疼痛及腫塊。白血球上升(72.2%)是最 重要的實驗室數據;其中2位病人在住院初期時有敗血性休克。9位病人由電腦斷 層檢查確定診斷,超音波及核磁共振檢查各診斷一例。所有的病人皆接受抗生素及 引流治療,其中9例以外科手術引流,而其它的2例是在電腦斷層指引下接受經皮 引流。有2位病例死亡。因為大部份的腰肌膿瘍病例症狀並不明顯,臨床上要高度 懷疑才能早期診斷及治療。電腦斷層掃描是標準診斷工具,病患只要經過適當的抗 生素及完全引流治療,預後大都良好。 |
英文摘要 | Psoas muscle abscesses are rarely encountered yet, and pose diagnostic and therapeutic challenges because of nonspecific clinical presentations. We retrospectively reviewed the medical records of adults with a psoas muscle abscess who were admitted to our hospital from January, 1988 to May, 1998. Over this ten year period, psoas abscesses were found in 11 cases. Six cases were primary and Staphylococcus spp. was the most commonly isolated. Five cases were a secondary psoas abscess while urological problems were the most common underlying condition. Fever, chills, lower back or flank pain and a palpable mass were the most common manifestations. Only one patient presented the classic triad of fever, flank pain, and limitation of hip movement (a typical psoas sign). Leukocytosis was the most common laboratory finding. Two of 11 cases presented septic shock. Two patients were admitted to the hospital with the initial diagnosis of psoas abscesses. Computerized tomographic (CT) scans accurately confirmed the clinical diagnosis in 9 of 11 patients. Diagnosis was then established one each by ultrasound (US) and magnetic resonance imaging (MRI), respectively. Four of 11 patients had negative findings initially by US. All patients were managed with drainage and antibiotics, nine were drained surgically, and two were managed with percutaneous drainage under CT guidance. Two patients died. Because of the lack of the classic symptoms and signs in most cases, a high degree of suspicion is important for early diagnosis of psoas abscess. CT scan is the standard technique of diagnosis. The prognosis is generally good with appropriate antibiotic treatment and complete drainage. |
本系統中英文摘要資訊取自各篇刊載內容。