中国实用外科杂志

中国实用外科杂志

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隐源性细菌性肝脓肿临床特点分析

孙培伟，白雪莉，陈义刚，高顺良，张    匀，楼健颖，阙日升，梁廷波   

  1. 浙江大学医学院附属第二医院肝胆胰外科，浙江杭州 310009
  • 出版日期:2017-02-01 发布日期:2017-01-24

  • Online:2017-02-01 Published:2017-01-24

摘要：

目的    探讨隐源性细菌性肝脓肿的临床特点，为临床决策提供相关依据。方法    回顾性分析2013年1月至2016年6月间浙江大学医学院附属第二医院肝胆胰外科连续收治的86例细菌性肝脓肿病人的临床资料。根据病因分为隐源性组（51例）和非隐源性组（35例）。比较两组临床表现、实验室及病原学检查结果、治疗及预后情况。结果    隐源性组年龄、伴发胆管结石和恶性肿瘤比例低于非隐源性组，而男性病人和糖尿病病人比例高于非隐源性组（P<0.05）；隐源性组出现血小板降低和总胆红素升高的比例低于非隐源性组（P<0.05）；最常见病原菌为肺炎克雷伯菌，但隐源性组肺炎克雷伯菌的检出率明显高于非隐源性组（P<0.05），而大肠埃希菌的检出率低于非隐源性组（P<0.05）；两组治疗均以抗生素联合穿刺引流为主，但隐源性组住院时间较短，预后不良事件的发生率较低（P<0.05）。 结论    隐源性细菌性肝脓肿好发于中老年男性糖尿病病人，主要病原菌为肺炎克雷伯菌，以控血糖、抗感染、积极穿刺引流为治疗原则，预后较好。

关键词: 肝脓肿, 隐源性, 预后

Abstract:

Clinical characteristics of cryptogenic pyogenic liver abscess        SUN Pei-wei, BAI Xue-li, CHEN Yi-gang, et al. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
Corresponding author: LIANG Ting-bo, E-mail: liangtingbo@zju.edu.cn
Abstract    Objective    To explore the clinical characteristics of cryptogenic pyogenic liver abscess (PLAC) and provide evidence for clinical decisions. Methods    The clinical data of 86 patients with PLA admitted in Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to June 2016 were analyzed retrospectively. According to etiology, the patients were classified as cryptogenic group (n=51) and non-cryptogenic group (n=35). Clinical manifestation, laboratory and pathogenic examination, treatment and prognosis were compared. Results    Compared with non-cryptogenic group, the mean age and rate of biliary calculi and malignance were lower in cryptogenic group, while the rate of male and diabetes mellitus were higher (P<0.05). The rates of decreased PLT and elevated TBil in cryptogenic group were lower than those of non-cryptogenic group (P<0.05). Although klebsiella pneumoniae was the main pathogen in both groups, its rate in cryptogenic group was higher than that in non-cryptogenic group, while the rate of E. coli was lower in cryptogenic group (P<0.05). The cryptogenic group had better prognosis, which presented shorter hospital stay and less adverse events (P<0.05). Conclusion    PLAC tends to appear mostly in middle-aged and old men with diabetes mellitus. Klebsiella pneumoniae is the major pathogen. Controlling serum glucose, anti-infection and percutaneous drainage are effective treatment methods to gain better prognosis. 

Key words: liver abscess, cryptogenic, prognosis