35例肝脓肿临床分析

The clinical analysis of 35 cases liver abscess

目的分析肝脓肿的临床影像学特征,旨在提高对本病的诊治水平。方法对临床和细菌培养确诊的35例资料完整病例进行回顾性分析,总结肝脓肿的临床、实验室、影像学及诊治特征。结果男24例,男女之比1:0.46,平均55岁。94.3%有发热史,平均体温39.3℃。临床以腹痛为主占68.6%,其次肝区叩击痛51.4%、腹部压痛42.9%。WBC总数平均为12.445/mm3,WBC分类97.1%显示中性粒细胞和单核细胞增多,淋巴细胞降低。伴随病变以糖尿病最多见占31.4%,其次胆系疾病、消化系疾病和各种大型手术后。US78.6%呈低回声囊性肿块,其中63.6%显示肿块后回声增强,77.3%囊壁不规则。CT81.8%为CT值<20Hu低密度,多为圆形单发性,边缘模糊,87.5%可见环形强化,其中单或双环征占76.2%。MRI均为T1低信号、T2高信号,环形强化占88.2%,其中单或双环征占86.7%。94.3%治疗痊愈出院,2例死于恶性肿瘤复发。结论本病临床主要表现为发热、腹痛及肝区叩击痛,WBC升高且为中性粒细胞、单核细胞升高和淋巴细胞降低为主,常合并糖尿病、胆系和消化系疾病,US主要表现为囊性低回声及肿块后回声增强,CT和MRI以环形强化,单或双环征为特征,治疗以穿刺引流结合大剂量抗生素应用效果最好。

Objective To improve the accuracy of diagnosis through summarizing clinical-radiographic characters of liver abscess, Methods By retrospectively analyzing 35 cases, we discussed the clinical manifestations, ultrasound and radiographic appearance of hepatic abscess, as well as the diagnosis principles. Results Most of the patients were males （n=24, M：F=1：0.46）. The mean age was 55. The most common symptoms were fever （in 90% of patients with a mean temperature of 39.3℃）, abdominal pain（in 68.2% of cases）, hepatic area percussion pain （in 51.4% of cases）, abdominal tenderness （in 42.9% of cases）. Blood routine showed elevated white blood cell count （the mean number is 12.445/mm^3） with neutrophils and monocytes increased and lymphocytes decreased （in 97.1% of cases）. In our study, the most common complication was diabetes（ in 31.4% of patients）, other include biliary tract or gastrointestinal diseases or postoperation. Ultrosound showed hypoechoic cystic nodules （in 78.6% of patients） with kt behind the nodules （in 63.6% of patients） and no clear margins（in 77.3% of patients）. Appearance on CT scan included focal low-attenuation areas with CT value〈20Hu （in 81.8% of cases） which often were round, single with no clear margin combined with annular enhancement （）,single or double target signs. Conclusion The mare symptom of hepatic abscess were fever,abdominal pain and percussion pain of liver area, the count of WBC increased mainly appeared the increase of the neutrophils and monocyte,the decreased of the lymphocyte also, hepatic abscess often combine with diabetes,bihary and digestive disease. US main appearance was hypoechoic cystic nodules and t behind the nodule, the character of CT and MRI appearance was annular enhancement, single or double target sign, interventional （imageguided） percutaneous drainage combined with antibiotic therapy were efficient.