Lee K T, Wong S R, Sheen P C
Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Dig Surg. 2001;18(6):459-65; discussion 465-6. doi: 10.1159/000050194.
BACKGROUND/AIMS: Despite continuous improvement in image modalities, availability of potent antibiotics and advancement in the knowledge and treatment of pyogenic liver abscess, mortality remains high. The high mortality rate has underlined the important role of prognostic factors and prompts a number of studies to identify the risk factors. The present study aims to audit our experience in managing patients with pyogenic hepatic abscess during the period of 1989-1999, and to document changes in etiology, bacteriology and outcome, and to identify any risk factor associated with mortality.
One hundred and thirty-three patients with pyogenic hepatic abscess were studied to determine the demographic characteristics, clinical features, laboratory, bacteriological findings, methods of treatment, final outcome and risk factor analysis. All patients were treated with parenteral antibiotics. One hundred and twelve patients were subjected to ultrasound-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in all patients. Laparotomy was done in 21 patients.
The overall hospital mortality rate was 6% (8/133). Biliary tract disease was the most frequently identified cause. Leukocytosis, hypoalbuminemia and hyperbilirubinemia were common laboratory findings. The most common microorganism cultured was Klebsiella pneumoniae. The most common concomitant disease was diabetes mellitus. On univariate analysis, large abscess, diabetes mellitus and sepsis were significantly associated with hospital mortality. On multivariate logistic regression analysis, the presence of sepsis (p = 0.0031) was found to be an independent risk factor.
In addition to early diagnosis and prompt treatment, making every effort to treat patients with adverse prognostic factors and systemic complications, the hospital mortality rate will be decreased significantly.
背景/目的：尽管影像技术不断改进，强效抗生素可及，且化脓性肝脓肿的知识和治疗取得进展，但死亡率仍然很高。高死亡率凸显了预后因素的重要作用，并促使多项研究去识别危险因素。本研究旨在回顾我们在1989年至1999年期间管理化脓性肝脓肿患者的经验，记录病因、细菌学和结局的变化，并识别与死亡率相关的任何危险因素。
对133例化脓性肝脓肿患者进行研究，以确定人口统计学特征、临床特征、实验室检查、细菌学检查结果、治疗方法、最终结局及危险因素分析。所有患者均接受静脉抗生素治疗。112例患者接受了超声引导下经皮穿刺脓肿抽吸。所有患者在抽吸后均插入了经皮引流导管。21例患者进行了剖腹手术。
总体医院死亡率为6%（8/133）。胆道疾病是最常见的病因。白细胞增多、低白蛋白血症和高胆红素血症是常见的实验室检查结果。培养出的最常见微生物是肺炎克雷伯菌。最常见的伴随疾病是糖尿病。单因素分析显示，大脓肿、糖尿病和脓毒症与医院死亡率显著相关。多因素逻辑回归分析发现，脓毒症的存在（p = 0.0031）是一个独立的危险因素。
除早期诊断和及时治疗外，尽一切努力治疗具有不良预后因素和全身并发症的患者，医院死亡率将显著降低。
