重症急性胰腺炎并发细菌性肝脓肿的诊断与治疗(附11例报告)

Diagnosis and treatment of severe acute pancreatitis with pyogenic liver abscess(A report of 11 cases)

目的 探讨重症急性胰腺炎(SAP)并发细菌性肝脓肿(PLA)的临床特点、治疗方案及预后转归,以期为临床诊疗提供借鉴。方法 回顾性分析南京大学医学院附属金陵医院2015年1月至2021年6月连续住院的SAP病人中并发PLA的临床资料。结果 在住院的3285例SAP中并发11例PLA(发生率为0.33%),其中死亡3例(病死率为27.3%)。PLA中8例发生于SAP病程晚期(10周后),所有病例均明确为胆源性病因,且伴有糖尿病病史,10例在病程中伴多器官功能障碍(90.9%)、7例伴腹腔出血(63.6%)、7例伴消化道瘘(63.6%)等胰外并发症,7例接受了胆囊穿刺引流(63.6%)等胆道干预措施。PLA发生部位右叶多于左叶(9例vs.2例),多发高于单发(7例vs. 4例)。在8例细菌学培养结果中6例为肺炎克雷伯菌(75.0%)。3例病人单独应用抗生素治疗,余8例在确诊PLA后中位天数3.5(1~27)d予CT引导下经肝穿刺脓肿引流。结论 PLA是SAP晚期罕见的并发症,病死率高,主要继发于胆源性胰腺炎合并糖尿病史的病人,肺炎克雷伯杆菌为其主要病原菌。

Objective To investigate the clinical characteristics,treatment,and prognosis of severe acute pancreatitis(SAP) with pyogenic liver abscess(PLA) so as to provide some clinical experience.Methods A retrospective analysis of consecutive SAP patients with PLA admitted to Jinling Hospital,Medical school of Nanjing University,from January2015 to June 2021.Results During the study period,a total of 11(0.33%) developed PLA in 3285 patients admitted with SAP,and three of the 11 patients(27.3%) died.PLA occurred in the late phase of SAP(>10 weeks) in eight cases.All the PLA patients were associated with biliary pancreatitis and a history of diabetes mellitus(DM).In the course of PLA,10(90.9%) of 11 cases were presented with multiple organ dysfunction syndromes(MODS),7(63.6%) had abdominal bleeding,7(63.6%) had gastrointestinal fistulae and 7(63.6%) received gallbladder drainage.PLA was more observed in the right lobe than in the left lobe(9 vs.2) and was multiple in 7 and single in 4 patients.Six(75.0%) were positive for Klebsiella pneumonia in 8 abscess specimens.Three patients were managed with antibiotics alone,while the remains received CT-guided percutaneous transhepatic drainage at a median of 3.5 days(1-27 days) after the diagnosis of PLA.Conclusion PLA is a rare complication in the late phase of SAP with a high mortality rate,mainly secondary to biliary pancreatitis and accompanied by DM.Klebsiella pneumonia is a common pathogen.