细菌性肝脓肿诊治的体会——附325例临床分析

THE DIAGNOSIS AND TREATMENT OF BACTERIAL LIVER ABSCESS—CLINICAL ANALYSIS OF 325 CASES

本文报告1981年至1993年收治325例肝脓肿,男222例(68.3％),女103例(31.7％),年龄自2岁～73岁,平均为27.3岁。来自农村占85.5％,发病原因:血源性100例(30.8％),胆道感染79例(24.3％),门脉性10例(3.1％),隐源性136例(41.8％)。右叶233例(71.7％),左叶72例(22.2％),两叶20例(6.1％),单发285例(87.7％),多发4例(12.3％)。脓量3～1700ml,多数40～200ml。典型症状254例(78.2％),不典型症状71例(21.8％)。X线检查阳性率75.1％,A超阳性率92.3％,B超阳性率94.1％,核素扫描84.6％,CT100％。术前明确诊断310例(95.4％),术中诊断15例(4.6％)。脓液培养165例中91例呈阳性(55.2％),其中金葡菌54例,大肠杆菌16例,枸橼酸杆菌5例,绿脓杆菌4例,变形杆菌4例,肺炎杆菌3例,其他5例,厌氧菌44.8％,细菌培养阴性可能为厌氧菌感染。 单纯抗生素治疗在1985年前占22.6％,1985年后占28.8％;经皮肝穿刺及置管引流,1985年前仅用于7.6％的病例,1985年后达47％;手术治疗以肋缘下切口经腹引流为主,1985年前占病例数的69.8％,1985年后为24.2％。本组病死率为2.15％,比国内外报道均低。本文对病因、诊断及治疗进行了讨论。

From 1981~1993, 325 patients with liver abscess were treated in the authors' hospital. 222 were males (68. 3%) and 103 females (31. 7%) . Age ranged from 2 to 73 years with a mean of 27.3 years. Most cases (85. 5%) .came from the country side. Secondary infection could be traced from the blood stream in 100 cases(30. 8%),from biliary tract in 79 cases(24. 3%),from portal vein in 10 cases (3.l%),from unknown or occult source in 136 cases (41.8%) Right lobe abscess occurred in 233 cases (71. 7%), left, lobe, 72 cases (22.2%) , and both lobes,20 cases(6. 1%). There were single abscess in 283 cases(87. 7%) and multiple abscesses in 42 cases(12. 3%). The amount of pus was from 3 to 1700ml, mostly was 40 ~ 200ml. 254 cases had typical symptoms and signs (78. 2%). 71 cases were atypical(21. 8%). The positive rates of the following diagnostic tests were by Roentgenographic examination,75.1%. By A type ultrasonic scanning, 92.3% B type ultrasonic imaging, 94.1%. Radioisotope study,84. 6%. and computed tomography, 100%. Preoperative diagnosis was established in 310 cases(95. 4%). In other 15 cases(4.6%) , the diagnosis was relied on laparatomy. 91 of 165 cases had positive pus culture(55. 2%). Staphylo-coccus Aureus were found in 54 cases,Escherichia coli were in 16 cases,Citro bacter were in 5 cases,Pseudomonas aeruginosa were in 4 cases,Proteus vulgaris were in 4 cases, Klebsiella pneumonia were in 3 cases, others were in 5 cases. Anaerobic infection occurred possibly in 44. 8% of the cases. Antibiotic therapy as the only means accounted for 22. 6% before 1985,after 1985 it was 28. 8%. Percutaneous transhepatic aspiration and catheter drainage was carried on for only 7. 6% of cases before 1985,but after 1985 it was 47%. Operative treatment using the right upper abdomen subcostal incision and trans-abdominal drainage was in 69.8% before 1985, but was only in 24. 2% after 1985. The mortality was 2.15% in this group. It is lower than other competable reports domestically and abroad. The etiology, diagnosis and treatment of liver abscess were discussed.