胆道术后肝脓肿的原因分析及诊治

TO STUDY THE CAUSES AND TREATMENT OF LIVER ABSCESS AFTER BILIARY OPERATIONS

目的探讨胆道系统术后并发肝脓肿的原因和治疗。方法9例肝内外胆管结石病人经各种胆道手术后肝脏内形成脓肿;明确诊断后,在B超引导下经皮肝穿刺引流和对脓腔进行抗菌素灌洗,2例行手术治疗。结果5例患者脓肿愈合,2例脓腔明显缩小,另2例行手术治疗病人已治愈。结论分析肝内脓肿形成的主要原因为(1)胆道损伤;(2)肝内胆管结石残余;(3)十二指肠液返流;(4)T管引流不畅,胆道梗阻,胆汁滞留。在B超引导下经皮肝穿刺脓肿引流及选用敏感抗菌素对脓腔进行灌洗是治疗胆道术后并发肝脓肿的有效手段。但脓液引流不畅病人应及时作有效的手术引流,并同时去除病因。

Objective To study the causes and treatment of abscess formation in the liver parenchyma after hepatic biliary tract system operation. Methods Ninecases of liver abscess formation after biliary system operation were reported . Each of them was percutaneously drained under ultrasound guidance and flushed with sensitive antibiotic every day. Results 5 abscesses were complete cured ,2 abscesses decreased remarkably in size, the other 2 healed after reoperation. Conclusion The main causes of liver abscess after biliary tract surgery were the damage of biliary tract , bile duct postoperative residual stone, duodenum liquid reflux , dissatisfied tube drainage , biliary tract obstruction, cholestasis. Effective drainage and flush with sensitive antibiotic were the treatment of choice. On the other hand , an efficient reoperation must he acted when the case has dissatisfied bile drainage , so the cause removed.