Psoas Muscle Abscess-Diagnosis and Approaches of Treatment

腰肌膿痬是一種罕見且困難早期診斷的疾病，除非醫師能有高度的懷疑而進一步檢查。因爲症狀表現的多樣性及不確定性，常常使得診斷延遲，而造成治療上的保守以致於合併症的增加及住院日數的增加。典型的症狀包括：發燒、腰痛、腹痛、髖關節屈曲攀縮、坐骨神經痛及跛腳。其他症狀包含體重降低、腹部腫塊、嘔吐、腹瀉、下肢腫塊、下肢疼痛及畏寒。在1999年一月至2000年六月間，共有六個病人因腰肌膿痬合併不同程度敗血症被送到台大醫院，其中除了病患年齡較大外並無明顯的危險因數。保守及支援性療法或許可以暫時穩住生命跡象但是膿痬引流則是一必要的步驟。膿痬引流可由電腦斷層指引或由開刀手術完成，手術方式有經腹腔引流、低位腹壁肌肉分離、大腿縱切及背部的切開引流等方式。我們偏好經由腰部三角橫向背部切開引流，如果大腿的感染症狀明顯可合併大腿縱向切開引流。有效的引流及適當的抗生素治療依然是治療因感染性疾病造成膿痬的不二法門。

關鍵字

無資料

並列摘要

Psoas muscle abscess is rare and presents a diagnostic challenge requiring a high index of suspicion. The relative obscurity of this entity, coupled with a typically insidious presentation, frequently result in diagnostic delays, attempts at conservative treatment, increased morbidity and prolong or recurrent hospitalization. Classic symptoms include fever, flank pain, abdominal pain, hip flexion contracture, sciatica and limp. Other symptoms include weight loss, abdominal mass, nausea, vomiting, diarrhea, limb mass, limb pain and chills. There were six cases of psoas muscle abscess with various degree of sepsis from January 1999 to June 2000. There was no significant risk factor to induce psoas muscle abscess except old age. The conservative and supportive treatment may stabilize the vital signs but surgical intervention and drainage must be done to treat the patients with psoas muscle abscess. The drainage procedures could be achieved via CT-guided drainage or surgical intervention. There are several methods to approach the psoas muscle, including anterior extraperitoneal, trans-abdominal, thigh and back incision. We preferred transverse back incision via the lumbar triangle to approach the psoas muscle and combined with groin incision if the erythema at the thigh is marked. Effective drainage and proper antibiotics are still the gold standard to treat the abscess resulted in the infectious diseases.

並列關鍵字

psoas muscle abscess ； sciatica ； back incision ； lumbar triangle

國際替代計量

Psoas Muscle Abscess-Diagnosis and Approaches of Treatment

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