肺炎克雷伯杆菌性肝脓肿不同介入治疗方法的比较  

Klebsiella pneumoniae liver abscess:comparison between the different treatment protocols

作　　者：李婧[1] 符颖[1] 王吉耀[1] 涂传涛[1] 李蕾[1] 沈锡中[1] 蒋炜[1] 

机构地区：[1]复旦大学附属中山医院消化内科,上海200032

出　　处：《临床肝胆病杂志》2010年第4期428-431,共4页Journal of Clinical Hepatology

摘　　要：目的本研究通过比较不同介入治疗措施对肺炎克雷伯杆菌性肝脓肿(KLA)疗效的影响以探寻相宜临床治疗流程。方法对2001年3月至2009年1月间收住入中山医院的106例KLA患者的临床资料进行回顾性分析,按治疗措施的不同将患者分为单纯穿刺组、穿刺+药物冲洗组、穿刺+单纯置管引流组及穿刺+药物冲洗+置管引流组,各组均静脉应用抗生素静脉治疗。结果与单独穿刺组相比,穿刺后行药物冲洗对KLA疗效差异无统计学意义(P>0.05);穿刺+单纯置管组在缩小脓肿直径方面明显优于单纯穿刺组及穿刺+药物冲洗组,(34.38±3.25)mm vs(22.67±2.37)mm vs(24.45±3.17)mm,(P<0.05);而在以甲硝唑为基础的二联抗生素应用方面,联用氟喹诺酮类或三代头孢菌素对KLA疗效差异无统计学意义(P>0.05)。结论 B超引导下经皮肝脓肿穿刺并留置导管体外引流,同时积极静脉应用抗生素是比较合理的KLA治疗程序。Objective The aim of the study is to compare the efficacy of the different protocols for treatment of Klebsiella pneumoniae liver abscesses（KLA） Methods 106 KLA patients who were treated in Zhongshan Hospital between March 2001 and January 2009 were studied retrospectively.The patients were divided into four groups based on the different therapeutic measures： mono-puncture,puncture with antibiotic flushing,puncture with retained catheter,and puncture with antibiotic flushing and retained catheter.All patients were treated with antibiotics intravenously.Results Compared to the mono-puncture,additional antibiotic flushing did not further improve clinical outcomes（P0.05）.However,the diameter of the abscess decreased significantly with the retained catheter therapy compared to the mono-puncture or additional antibiotic flushing therapy（34.38±3.25 mm vs 22.67±2.37 mm vs 24.45±3.37 mm,P0.05）.Combined therapy with metronidazole,tert-cephalosporin and fluoroquinolones did not show a significant difference（P0.05）.Conclusion B-ultrasound guided puncture with retained catheter and intravenous antibiotic treatment is reasonably effective for KLA.

关 键 词：肝脓肿 克雷伯菌 肺炎 

分 类 号：R575.4[医药卫生—消化系统]