2型糖尿病并发肝脓肿的临床分析

Clinical Analysis of Type 2 Diabetes Complicated with Live Abscess

目的:探讨糖尿病合并细菌性肝脓肿(DLA)的临床特点及最佳治疗方案,减少漏诊、误诊,避免患者致残,提高临床治疗水平。方法:对我院2000年1月至2007年12月收治的28例糖尿病合并细菌性肝脓肿患者的临床资料进行回顾性归纳分析。结果:DLA患者28例,占同期收治细菌性肝脓肿的43.07%(28/65例),均为2型糖尿病,大多合并胆系疾病(46.4%),临床表现不典型,明显腹痛并不常见(28.57%),普遍存在肝功能损害(57.1%),细菌培养阳性率低(40%),主要为肺炎克雷伯菌和尿肠球菌,治疗不及时易出现全身其他部位化脓性迁徙性病灶,治疗中8例临床治愈,18例临床好转,治疗总有效率达92.8%。结论:DLA临床表现复杂,易漏诊误诊;及早诊断治疗以减少全身其他部位化脓性迁徙性病灶,避免患者致残;在治疗DLA时,早期足量应用有效抗生素、注重控制血糖与控制感染并重及适时脓肿穿刺引流是治疗的关键。

Objective：To study the diabetic patients with bacterial liver abscess （DLA）and the, pro- grammes to reduce misdiagnosis,avoid patients disabled, and improve the level of clinical treatment. Method：From Jan. 2000 to Dec. 2007,28 cases diabetes complicated with bacterial abscess of the liver inpatients were reviewed the clinical data retrospectively. Result： 28 patients with DLA, 43.07% （28/65） , type 2 diabetes are mostly with biliary disease（46.4% ） , a typical clinical manifestations, abdominal pain is not obvious common （28.57%） , common hepatic dysfunction （57.1%） , the low rate of positive bacterial culture （40%） , mainly urine Klebsiella pneumonia and enterococci, timely treatment is not easy in other parts of suppurative body movemen tlesions, the treatment of eight cases of clinically cured, 18 patients improved treatment efficiency of the total 92.8%. Conclusion： DLA complex clinical performance, easy misdiagnosis ; early diagnosis and treatment to reduce body movement in other parts of pyogenic lesions, patients avoid main in the treatment of DLA, early adequate application of effective antibiotics, and blood sugar control on both infection control and timely treatment of abscess drainage is the key.