Lobo D N, Dunn W K, Iftikhar S Y, Scholefield J H
Department of Surgery, University Hospital, Nottingham.
Ann R Coll Surg Engl. 1998 Nov;80(6):405-9.
Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. Psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.
大多数外科医生认为腰大肌脓肿是一种与脊柱结核相关的极为罕见的病症，但在当代外科实践中，它们更常见于胃肠道疾病的并发症。对特伦特地区中部两家大型医院在两年期间内接受腰大肌脓肿治疗的所有患者进行了病例记录研究。所有七名患者均出现发热、腰大肌痉挛、压痛性肿块和白细胞增多。一名患者通过腹部X光片确诊，三名通过CT扫描确诊，两名通过MRI确诊，一名通过超声确诊。病因包括克罗恩病3例、阑尾炎2例、乙状结肠憩室炎和转移性结直肠癌各1例。六名患者接受了经腹病变肠段切除术、腹膜后清创术和脓肿腔体外引流。一名患者接受了经皮引流。两名患者因并发症接受了不止一次手术探查。无死亡病例，住院时间为8 - 152天。腰大肌脓肿可能是一个棘手且病程漫长的问题。对于并发于胃肠道疾病的腰大肌脓肿，肠段切除、彻底清创、体外引流及联合使用抗生素至关重要。可能需要行造口术使肠道失功。然而，在某些情况下可能需要多学科方法，因为腰大肌脓肿可能累及骨骼和关节。
