暴发性肝脓肿12例诊治体会  

Diagnosis and treatment of fulminant liver abscess:A report of 12 cases

作　　者：尹大龙[1] 刘连新[1] 姜洪池[1] 

机构地区：[1]哈尔滨医科大学附属第一医院肝脏外科肝脾外科省部共建教育部重点实验室,黑龙江哈尔滨150001

出　　处：《中国实用外科杂志》2015年第9期984-987,共4页Chinese Journal of Practical Surgery

基　　金：高等学校博士学科点专项科研基金资助课题(No.20132307120036);中国博士后科学基金面上资助(No.2014M551273)

摘　　要：目的探讨暴发性肝脓肿的发病特点、临床表现及预后和转归,为其诊断和治疗提供有益的借鉴。方法回顾性分析哈尔滨医科大学附属第一医院2007年1月至2014年12月连续住院的500例肝脓肿病人中12例暴发性肝脓肿病人的临床资料。结果暴发性肝脓肿发病率为2.4%,首诊误诊率为67%,病死率为25%。发热寒战、腹痛和黄疸为其主要的临床表现,同时伴有多器官功能障碍,以累及呼吸系统最为常见。50%暴发性肝脓肿病人合并糖尿病,91.7%的病原菌为肺炎克雷伯杆菌。在暴发性肝脓肿第一阶段由于脓肿液化不充分,主要以支持治疗为主。第二阶段脓肿逐渐液化后应尽早在超声引导下穿刺或置管引流脓汁。结论暴发性肝脓肿具有发病急、进展快,误诊率、并发症发生率和病死率高的特点,肺炎克雷伯杆菌为其主要病原菌。治疗原则应在抗炎治疗的同时积极纠正多器官功能障碍,尽早引流脓肿。Objective To investigate the characteristics, clinical manifestations and prognosis of fulminant liver abscess （FLA）, provide useful references for its diagnosis and treatment. Methods The clinical characteristics, laboratory tests, imaging studies and treatment of 12 cases of FLA in 500 consecutive cases of liver abscess admitted from January 2007 to December 2014 in the First Affiliated Hospital of Harbin Medical Univers!ty were analyzed retrospectively. Results The incidence of FLA was 2.4% with first misdiagnosis rate of 67%, and the mortality rate was 25%. Fever, abdominal pain and jaundice were the most common clinical manifestations, accompanied by multiple organ dysfunction syndrome （firstly respiratory system dysfunction）. Half of cases of FLA have diabetes, and 91.7% of the pathogen were Klebsiellapneumoniae. Support treatment was employed in the first phase due to insufficient liquefaction abscesses and percutaneous drainage guided by uhrasound in the second stage as soon as possible. Conclusion FLA has the characteristics of overwhelming progress, high first misdiagnosis rate, high complication incidence and high mortality. Klebsiellapneumoniae is the main pathogen of FLA and percutaneous drainage guided by ultrasound should be employed as soon as possible.

关 键 词：肝脓肿 脓毒症 多器官功能障碍 

分 类 号：R6[医药卫生—外科学]