细菌性肝脓肿的发病特点与诊治变迁

Clinical characteristics and treatment changing of pyogenic liver abscess

细菌性肝脓肿是肝胆系统常见的感染性疾病,对于有糖尿病、合并心血管疾病等高危因素的易感人群,当出现发热、腹痛等临床表现时,应警惕该疾病的存在。近年来,细菌性肝脓肿从发病特点,高危因素,致病菌到治疗手段都发生很大的变化。常见致病菌主要是革兰阴性杆菌,如大肠埃希菌和肺炎克雷伯杆菌,肺炎克雷伯杆菌已经成为肝脓肿的首要致病菌,其临床表现也除单纯肝脏侵犯外常合并肝外侵袭,如眼内炎和中枢神经系统感染等。细菌性肝脓肿的主要实验室变化是C反应蛋白和白细胞升高,结合超声或者CT影像学可以很好鉴别诊断。在抗生素治疗的同时,治疗手段也从传统手术引流向超声或者CT引导的脓肿穿刺引流转变。本文就上述问题进行综述。

Pyogenic liver abscess(PLC)is a common infectious disease in the hepatobiliary system.For people with high risk factors such as diabetes mellitus and cardiovascular diseases,the presence of this disease should be warned when clinical manifestations including fever and abdominal pain occur.In recent years,great changes were observed in the characteristics,high risk factors,pathogenic bacteria and treatment strategy of PLC.The most common pathogens of liver abscess are so-called Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae and Klebsiella.pneumoniae has replaced Escherichia coli as the most common microorganism isolated from PLA infections.As liver abscesses caused by Klebsiella.pneumoniae can produce invasion syndromes,including endophthalmitis,central nervous system infection,other extrahepatic infections.The most common laboratory abnormality among included items was increased C-reactive protein and white blood cell levels.Pyogenic liver abscess can be diagnosed differently via ultrasound or CT scan from other liver lesions.Once recognized,percutaneous drainage guided by ultrasound and CT and antibiotic treatment are the mainstay of management for PLA.The aim of this article is to review clinical characteristics and treatment changing in recent years.