中国实用外科杂志

中国实用外科杂志

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重症急性胰腺炎并发细菌性肝脓肿的诊断与治疗（附11例报告）

姜文迪1，高    堃2，叶    博1，柯    路1，李    刚1，周    晶1，童智慧1，2，刘玉秀2，李维勤1，2   

  1. 1南京大学医学院附属金陵医院（东部战区总医院），江苏南京210002；2南京医科大学金陵临床医学院，江苏南京210002
  • 出版日期:2022-12-01

  • Online:2022-12-01

摘要： 目的    探讨重症急性胰腺炎（SAP）并发细菌性肝脓肿（PLA）的临床特点、治疗方案及预后转归，以期为临床诊疗提供借鉴。方法    回顾性分析南京大学医学院附属金陵医院2015年1月至2021年6月连续住院的SAP病人中并发PLA的临床资料。结果    在住院的3285例SAP中并发11例PLA（发生率为0.33%），其中死亡3例（病死率为27.3%）。PLA中8例发生于SAP病程晚期（10周后），所有病例均明确为胆源性病因，且伴有糖尿病病史，10例在病程中伴多器官功能障碍（90.9%）、7例伴腹腔出血（63.6%）、7例伴消化道瘘（63.6%）等胰外并发症，7例接受了胆囊穿刺引流（63.6%）等胆道干预措施。PLA发生部位右叶多于左叶（9例vs.2例），多发高于单发（7例 vs. 4例）。在8例细菌学培养结果中6例为肺炎克雷伯菌（75.0%）。3例病人单独应用抗生素治疗，余8例在确诊PLA后中位天数3.5（1~27）d予CT引导下经肝穿刺脓肿引流。结论    PLA是SAP晚期罕见的并发症，病死率高，主要继发于胆源性胰腺炎合并糖尿病史的病人，肺炎克雷伯杆菌为其主要病原菌。

关键词: 重症急性胰腺炎, 细菌性肝脓肿, 胆源性胰腺炎, 肺炎克雷伯菌

Abstract: Diagnosis and treatment of severe acute pancreatitis with pyogenic liver abscess（A report of 11 cases）        JIANG Wen-di*, GAO Kun, YE Bo, et al.  *Jinling Hospital, Medical School of Nanjing University(General Hospital of Eastern Theater Command), Nanjing 210002, China
Corresponding author: TONG Zhi-hui, E-mail: njzyantol@hotmail.com
Abstract    Objective    To investigate the clinical characteristics, treatment, and prognosis of severe acute pancreatitis (SAP) with pyogenic liver abscess (PLA) so as to provide some clinical experience. Methods    A retrospective analysis of consecutive SAP patients with PLA admitted to Jinling Hospital, Medical school of Nanjing University, from January 2015 to June 2021. Results    During the study period, a total of 11 (0.33%) developed PLA in 3285 patients admitted with SAP, and three of the 11 patients (27.3%) died. PLA occurred in the late phase of SAP(＞10 weeks) in eight cases. All the PLA patients were associated with biliary pancreatitis and a history of diabetes mellitus (DM). In the course of PLA, 10 (90.9%) of 11 cases were presented with multiple organ dysfunction syndromes (MODS), 7 (63.6%) had abdominal bleeding, 7 (63.6%) had gastrointestinal fistulae and 7 (63.6%) received gallbladder drainage. PLA was more observed in the right lobe than in the left lobe (9 vs. 2) and was multiple in 7 and single in 4 patients. Six(75.0%) were positive for Klebsiella pneumonia in 8 abscess specimens. Three patients were managed with antibiotics alone, while the remains received CT-guided percutaneous transhepatic drainage at a median of 3.5 days (1-27 days) after the diagnosis of PLA. Conclusion    PLA is a rare complication in the late phase of SAP with a high mortality rate, mainly secondary to biliary pancreatitis and accompanied by DM. Klebsiella pneumonia is a common pathogen.

Key words: severe acute pancreatitis, pyogenic liver abscess, biliary pancreatitis, klebsiella pneumoniae