1例疑诊细菌性肝脓肿患者的循证治疗  

Evidence-Based Treatment for a Patient with Suspected Pyogenic Liver Abscess

作　　者：陈思瑞[1] 彭兵[1] 蒋辉[1] 廖波[1] 李春林[1] 陈小东[1] 

机构地区：[1]四川大学华西医院普外二科,成都610041

出　　处：《中国循证医学杂志》2008年第4期291-293,共3页Chinese Journal of Evidence-based Medicine

摘　　要：目的为1例疑诊细菌性肝脓肿患者制定合理的外科治疗方案。方法针对患者的临床问题,以肝脓肿、开腹引流和腹腔镜等MeSH主题词和自由词,计算机检索Cochrane图书馆(2007年第4期)、MEDLINE(1996～2008.1)、Journal Club1991.1～2008.1)和中国期刊全文数据库(1994～2008.1),查找相关的系统评价、ACP(随机对照试验和临床回顾性研究等,并对所获证据进行质量评价。结果我们没有检索到关于腹腔镜引流与开腹引流对比治疗肝脓肿的系统评价和大样本随机对照试验,因此选择了与临床问题密切相关的4篇回顾性临床研究。其结果提示腹腔镜下引流治疗肝脓肿安全有效,具有手术时间短、创伤小、恢复快、费用低、并发症少等优点,是开腹手术的理想替代术式。但因病例数有限,还需要高质量、大规模临床随机对照试验来证实,因此我们结合医生经验和患者意愿,对该患者未采用腹腔镜引流治疗,而是实施开腹引流手术,最终患者痊愈出院。结论现有的4篇回顾性研究虽显示腹腔镜对肝脓肿患者安全有效,但患者例数有限,尚需高质量、大样本的随机对照试验证实。Objective To formulate an evidence-based treatment plan for a patient with suspected pyogenic liver abscess. Methods Based on the clinical questions raised by a patient with suspected pyogenic 1 iver abscess, we searched The Cochrane Library （Issue 4, 2007）, MEDLINE （1996 to January 2008）, ACP Journal Club （1991 to January 2008）, and Chinese Journal Full-text Database （1994 to January 2008） for systematic reviews, randomized controlled trials （RCTs） and case-control studies. The quality of the included studies was assessed. Results We did not find any systematic reviews or large-scale RCTs involving a comparison between laparoscopic drainage and surgical drainage in the treatment of pyogenic liver abscess. Four clinical retrospective studies closely related to our questions were found and assessed. These studies concluded that laparoscopic drainage for liver abscesses was a safe alternative for patients requiring surgical drainage. Based on the current evidence, as well as our clinical expertise and the patient＇s values, laparoscopic drainage was not used for this patient and surgical drainage was applied. The patient was recovered and discharged. Conclusion Current evidence showed that laparoscopic drainage might be effective and safe for 1 iver abscesses but high-quality large-scale randomized controlled trials are still required.

关 键 词：肝脓肿 开腹引流 腹腔镜 循证治疗 

分 类 号：R575.4[医药卫生—消化系统]