高危儿童肝脓肿38例临床分析

Clinical analysis on 38 high risk children with liver abscess

目的：分析探讨高危肝脓肿（LA）患儿的早期诊断识别及治疗方案的选择。方法：回顾性分析2005年1月-2013年4月该院收治儿童LA的临床病例资料,根据其临床表现和是否伴有并发症分为＂高危险组＂和＂低危险组＂,比较分析病因、临床表现、治疗及预后。结果：38例LA患儿中年龄（7.6±4.2）岁,细菌性肝脓肿（PLA）25例,阿米巴肝脓肿（ALA）10例;ALA和PLA有相似的临床和实验室检查特点;超声检查显示多房、多腔脓肿是PLA的一项特征性表现（12/25 vs0/10;P=0.006）。高危险组与低危险组的患儿相比,脓肿更大、中性分叶核粒细胞百分率增高〔（75±14）%vs（62±11）%;P=0.01〕、采用引流方法治疗的患儿较多（25/26 vs 6/12;P=0.03）。38例LA患儿中有37例康复出院,28例患儿脓肿完全消失,总治疗时间（46±60.8）天。结论：经皮穿刺置管引流术（PCD）在高危险LA患儿的治疗中效果更好,与开腹脓肿切开引流术（OSD）相比更安全、更有效、侵入性损伤较小,可作为高危儿童LA的首先治疗术式。

Objective： To analyze and explore early identification and diagnosis of liver abscess among high risk children and choice of therapeutic regimens. Methods ： The clinical medical data of children with liver abscess treated in the hospital from January 2005 to April 2013 were analyzed retrospectively. The children were divided into high risk group and low risk group according to clinical manifestations and combining with complications or not; the causes, clinical manifestations, treatments and prognosis of children in the two groups were compared and analyzed. Results ： The age of 38 children with liver abscess was （7.6 ± 4. 2） years old, 25 children were diagnosed as bacterial liver abscess and 10 children were diagnosed as amoebic liver abscess; the clinical characteristics and laboratory examination characteristics of bacterial liver abscess and amoebic liver abscess were similar; uhrasonography showed that muhiloculated abscess was a characteristic performance of bacterial liver abscess （ 12/25 vs. 0/10 ; P = 0. 006 ） . Compared with low risk group, abscesses were larger and the percentage of neutrophilic segmented granulocytes increased significantly [ （ 75 ± 14 ） % vs. （ 62± 11 ） % ; P = 0. 01 ], the percentage of children treated by drainage increased （25/26 vs. 6/12; P = 0. 03） . Among 38 children with liver abscess, 37 children left the hospital af- ter recovery, abscess disappeared completely in 28 children, the total treatment time was （46 ± 60. 8） days. Conclusion： The clinical effect of percutaneous catheter drainage is better in treatment of high risk children with liver abscess, compared with transabdominal abscess incision drainage, it is more safe, effective and less invasive, which can be used as a preferred method for high risk children with liver abscess.