细菌性肝脓肿临床特点的回顾性分析

目的:总结细菌性肝脓肿(pyogenic liver abscesses,PLA)的临床特点、诊断及治疗经验,提高诊疗水平。方法:回顾性分析哈尔滨医科大学第二临床医学院2013年1月-2014年12月收治的75例PLA患者的临床资料。结果:75例患者的平均年龄57岁,最大78岁,最小34岁。其中,男45例,女30例,男:女为1.5:1。75例患者中表现为发热者69例(92.0%)、寒战28例(37.3%)、右上腹痛66例(88.0%),伴恶心呕吐者28例(37.3%),黄疸15例(20.0%),肝肿大8例(10.7%)。有糖尿病病史患者28例(37.3%)。胆系疾病(78.7%)是本组资料主要的易患因素,其中53例患有胆囊炎(70.7%)。外周血白细胞增高67例(89.3%),血红蛋白降低41例(54.7%),白蛋白降低46例(61.3%);75例患者转氨酶升高58例(77.3%)。肝右叶单发脓肿多见(75例患者中36例,占48%)。51例B超确诊,24例行B超+CT或CT检查。48例行穿刺液细菌培养及25例血培养,其中肺炎克雷伯氏菌为主要病原菌。平均住院天数为19天,多数患者经皮下肝脓肿穿刺或置管引流而好转,1例漏诊为肺炎,2例患者反复入院,1例因菌血症死亡。结论:PLA的临床表现多样,以发热最为常见;多为肝右叶单发,部分患者血红蛋白及血清白蛋白降低。糖尿病为PLA最常见基础疾病,胆系疾病是主要的易患因素。肺炎克雷伯杆菌是本组PLA患者的主要致病菌。

Retrospective Analysis of the Clinical Characteristics of Pyogenic Liver Abscess

Objective:To summarize the clinical characteristics, diagnosis and treatment experience of pyogenic liver abscesses,improve the level of diagnosis and treatment.Methods:To retrospectively analyze the clinical data of diagnosis and treatment to the 75cases with pyogenic liver abscess fromThe Second Affiliated Hospital of Harbin Medical University between January 2013 to December2014.Results:The mean age of 75 cases was 57 years, the youngest was 34 years old, the maximum age was 78 years old. 45 male, 30female, the ratio of male to female was 1.5: 1. Most of the 75 cases characterized by fever accounted for 69 (92.0%) cases; chillsaccounted for 28 (37.3%) cases; right upper quadrant pain 66 (88.0%) cases; nausea, vomiting 28 (37.3%); jaundice 15 (20.0%);hepatauxe8 (10.7%). Diabetes (DM) is the most common complication 28 (37.3%). Biliary system diseases (78.7%) were the mainsusceptible factors, including 53 (70.7%) cases with cholecystitis. The proportion increased of the peripheral blood leukocytes count for67 (89.3%) cases; lower hemoglobin 41 (54.7%) cases; albumin deficiency 46 (61.3%) cases, most of the patients with elevatedaminotransferase 58 (77.3%) cases. Right lobe of single abscess accounted for 36 (48%). 51 cases being diagnosed by ultrasound B,otherwise 24 cases took CT examination. 48 cases took the pus culture and 25 cases took the blood culture in 75, pneumonia klebsiellawas the main pathogenic bacteria. Average hospitalization days was for 19 days. 23 cases simply apply antibiotic treatment, 71 cases byantibiotics and ultrasound-guided percutaneous abscess aspiration/catheter drainage. 1 case was misdiagnosed as pneumonia; 2 patientswere hospitalized repeatedly; 1 case died because of bacteremia.Conclusion:The clinical manifestations of PLA varied, fever is the mostcommon. Right lobe of single abscess accounts for high incidence. The hemoglobin and serum album of PLA reduced. Diabetes is themost common complication, and biliary system diseases were the main susceptible factors. In our group, is themajor pathogenic bacteria of PLA.