细菌性肝脓肿治疗的单中心20年回顾分析

Bacterial Liver Abscess:A Retrospective Analysis of Twenty Years' Experience in Single Center

目的分析近20年来单中心细菌性肝脓肿治疗方法和疗效的变化。方法回顾性分析我科1989年1月至2008年12月期间收治的198例细菌性肝脓肿患者的临床资料,按入院时间分为1989～1995年组、1996～2002年组及2003～2008年组,比较各组患者的性别、年龄、合并症、脓肿部位、脓肿个数、脓肿大小、治疗方法、住院时间、并发症发生率及死亡率。结果3组患者分别有54、69及75例;3组患者在性别、年龄、有无糖尿病、脓肿部位、脓肿个数及脓肿大小方面差异均无统计学意义(P>0.05)。1989～1995年组行开腹手术35例(64.8%)、腹腔镜手术8例(14.8%)、经皮穿刺抽吸/置管引流11例(20.4%);1996～2002年组行单纯抗生素治疗2例(2.9%)、开腹手术15例(21.8%)、腹腔镜手术21例(30.4%)、经皮穿刺抽吸/置管引流31例(44.9%);2003～2008年组行单纯抗生素治疗3例(4.0%)、开腹手术5例(6.7%)、腹腔镜手术13例(17.3%)、经皮穿刺抽吸/置管引流54例(72.0%)。3组患者的治疗方法构成比差异有统计学意义(P<0.05)。3组患者住院时间分别为(18.5±12.2)d、(16.4±12.8)d及(20.1±14.6)d,术后并发症发生率分别为9.3%(5/54)、4.3%(3/69)及4.0%(3/75),死亡率分别为3.7%(2/54)、1.4%(1/69)及1.3%(1/75),差异均无统计学意义(P>0.05)。结论随着外科技术的进步,有效的抗生素治疗、经皮置管引流或细针抽吸已成为细菌性肝脓肿的主要治疗方法,腹腔镜和开腹手术是必要的补充。

Objective To analyze the treatment and effect of bacterial liver abscess over the past two decades in one single center. Methods The total 198 patients with bacterial liver abscess during the last twenty years were studied retrospectively. They were divided into three groups according time： 1989--1995 group, 1996--2002 group and 2003- 2008 group. Gender and age of patient, location, number and size of abscesses, treatment, hospital days, morbidity of complications and mortality among the groups were compared. Results There were 54, 69, 75 cases in 1989--1995, 1996--2002 and 2003--2008 group respectively. No significant differences were found in gen- der and age of patient, location, number and size of abscess among three groups （P〉0.05）. In 1989--1995 group, 35 cases （64.8%） were treated with laparotomy, 8 cases （14.8%） with laparoseope, and 11 cases （20.4%） with percutaneous treatment （needle aspiration or catheter drainage）. In 1996--2002 group, 15 cases （21. 8%） were treated with laparotomy, 21 cases （30.4%） with laparoscope, 31 cases （44.9%） with percutaneous treatment （needle aspiration or catheter drainage）, and 2 cases （2.9%） were treated with antibiotherapy. In 2003--2008 group, 5 cases （6.7%） were treated with laparotomy, 13 cases （17.3%） with laparoscope, 54 cases （72.0%） with percutaneous treatment （needle aspiration or catheter drainage）, and 3 cases （4.0%） were treated with antibiotherapy. The constituent ratio of treatment was significantly different among three groups （P〈0.05）. The hospital days was （18.5±12.2） d, （16.4±2.8） dand （20.1±14.6） d, the morbidity of complications was 9.3% （5/54）, 4.3% （3/69） and 4.0% （3/75）, the mortality was 3.7% （2/54）, 1.4%（1/69） and 1.3% （1/75） respectively, but there were no significant differences of three indexes among three groups. Conclusion With the development of surgical techniques, effective antibiotic therapy and percutaneous treatment （needle aspiration or catheter drainage） have been the main therapeutic methods, and laparoscopy and laparotomy are necessary supplement.