细菌性肝脓肿58例

Pyogenic liver abscess:An analysis of 58 cases

目的:总结分析细菌性肝脓肿的临床特征及相关实验室检查结果,为该病的诊断和合理治疗提供依据.方法:总结我院2000-06/2011-12的58例确诊细菌性肝脓肿患者的临床资料,回顾性分析该病的临床特征、实验室检查、影像学、病原学及治疗特点.结果:58例细菌性肝脓肿患者最常见的临床表现为畏寒发热(94.8%)及右上腹痛(58.6%).糖尿病(46.5%)为最常见的合并症.血清碱性磷酸酶(77.6%)、白细胞(70.7%)和纤维蛋白原(60%)升高最常见.最常见的细菌为肺炎克雷伯菌(17.2%).脓肿多为单个(86.2%),肝右叶居多(81.1%).所有患者均选用联合抗生素治疗,其中26例患者(44.8%)行穿刺抽脓或置管引流,3例患者(5.2%)行手术治疗,1例患者(1.7%)死亡.结论:患者临床表现为畏寒发热、右上腹痛时应高度警惕细菌性肝脓肿可能,尤其是糖尿病、胆管疾病及恶性肿瘤患者.病原学仅在部分患者出现阳性结果,而血清碱性磷酸酶、白细胞和纤维蛋白原升高更常见,可能对临床诊断具有提示意义.抗感染结合穿刺抽脓或置管引流是临床安全有效的治疗手段.

AIM： To analyze the clinical features of pyogenic liver abscess （PLA） to provide the basis for early diagnosis and treatment of this disease. METHODS： The clinical data for 58 patients with PLA who were treated in the Second Affiliated Hospital of Nanjing Medical University from June 2000 to December 2011 were retrospectively analyzed to determine the clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. RESULTS： Fever and chills （94.8%） were the most common clinical manifestations, followed by right upper quadrant pain （58.6%）. Twenty-seven cases （46.5%） had diabetes mellitus. The most common laboratory abnormality was increasedalkaline phosphatase （ALP） （77.6%）, followed by increased white blood cell （WBC） count （70.7%） and fibrinogen （FIB） （60%）. The most commonly identified organism was Klebsiella pneumoniae （17.2%）. The majority of patients had solitary liver abscess （86.2%）, and most of liver abscesses were found in the right hepatic lobe with an average diameter of 7.1 cm ± 4.0 cm （1-24 cm）. All patients underwent combined antibiotic treatment. Ultra- sound or CT-guided needle aspiration or continu- ous drainage after needle aspiration of pyogenic liver abscess was performed in 26 patients （44.8%）. Surgery was required in 3 patients （5.2%）. One patient （1.7%） died due to septic shock after ad- mission. CONCLUSION： Patients who have fever, chills, and right upper quadrant pain should be con- sidered of pyogenic liver abscess, especially in patients with diabetes, biliary tract disease, or cancer. Elevated ALP, WBC and FIB were more commonly seen than positive bacterial culture in PLA patients, which may have suggestive significance in clinical diagnosis. Antibiotics combined with needle aspiration or continuous drainage after needle aspiration are safe and ef- fective treatments.