细菌性肝脓肿45例临床分析  

Clinical analysis of 45 patients with pyogenic liver abscess

作　　者：杨昀[1] 黄晓丹[1] 季国忠[1] 

机构地区：[1]南京医科大学第二附属医院消化医学中心,210011

出　　处：《中国临床研究》2012年第11期1052-1054,共3页Chinese Journal of Clinical Research

摘　　要：目的研究细菌性肝脓肿的临床特点、病原学及诊治进展。方法回顾性分析2006年1月至2011年12月45例肝脓肿患者的住院资料,总结其临床特点和诊治情况。结果 45例患者平均年龄62.8岁,临床表现中最多见为发热(42例,93.3%),其次为寒战(28例,62.2%)和上腹痛(22例,48.9%),大部分患者血白细胞升高(41例,91.1%),并有肝功能异常(33例,73.3%)。胆系疾病(35例,77.8%)和糖尿病(23例,51.1%)是主要易患因素。首选诊断方法为B超及CT检查(诊断率达95.5%),但有2例患者(8.9%)通过B超、CT及MRI检查仍未获确诊,需行经皮肝穿刺或手术剖腹探查。11例脓液培养和16例血培养阳性,21例患者(46.7%)细菌培养阴性。肺炎克雷伯杆菌为主要病原菌(59.3%)。头孢吡肟、头孢哌酮+舒巴坦、哌拉西林+他唑巴坦、亚胺培南及美罗培南对革兰阴性菌较为敏感;万古霉素、替卡西宁及阿米卡星对革兰阳性菌较为敏感。治疗方法包括单纯抗生素治疗,抗生素+经皮肝穿刺引流及抗生素+手术脓肿切开引流。结论细菌性肝脓肿的平均患病年龄明显增大,临床特点多样,病原检测以肺炎克雷伯菌最多见,胆系疾病和糖尿病是其最主要的易患因素。应根据患者个体性选择合适的治疗方法。Objective To investigate the clinical features, pathology, diagnosis and treatment of pyogenic liver abscess. Methods Clinical data of 45 patients with liver abscess admitted from Jan. 2006 to Dec. 2011 were analyzed retrospectively. Results The mean age of 45 patients was 62.8 years. The main manifestations were fever （42 cases,93.3% ）, chills （28 cases,62.2% ） and epigastralgia （22 cases,48.9% ）;elevated white blood cell count was seen in 41 cases （91.1% ）, and abnormal liver function was seen in 33 cases （73.3 % ）. Biliary diseases （35 cases,77.8 % ）and diabetes （23 cases,51.1% ） were predisposing factors of pyogenic liver abscess. Ulrasonography and CT were the first choice for diagnosis of pyogenic liver abscess with diagnostic rate of 95.5%. Percutaneous liver aspiration guided by ultrasonography or surgical exploratory operation were performed in 2 cases （8.9%） who failed to diagnose by ultrasonography, CT or MR image. Positive purulent secretion culture was seen in 11 cases ; positive blood culture was seen in 16 cases; negative bacteria culture result was seen in 21 cases （46.7%）. Klebsiella pneumonia was main pathogenic bacteria （59.3%）. Gram negative bacteria were sensitive to cefepime, cefoperazone plus sulbactam, piperacillin plus tazobactam,imipenem and meropenem, while Gram positive bacteria were sensitive to vancomycin, teicoplanin and amikin. The treatment included antibiotics use alone, antibiot- ics plus drainage by percutaneous puncturing liver abscess and antibiotics plus drainage by surgical incision of abscess. Conclusion The mean age of patients with pyogenic liver abscess increases obviously. Clinical manifestations are varied. Klebsiella pneumonia is the most common pathogen. Biliary diseases and diabetes are the major predisposing factors of pyogenic liver abscess. The appropriate treatment according to patients＂ individuality should be chosen.

关 键 词：细菌性肝脓肿 临床分析 治疗 

分 类 号：R575.4[医药卫生—消化系统]