阿米巴肝脓肿：针吸术与保守治疗的对比研究

Zafar Arshad, Ahmed Sajjad

Department of Surgery, Ayub Medical College, Abbottabad.

J Ayub Med Coll Abbottabad. 2002 Jan-Mar;14(1):10-2.

BACKGROUND

Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs.

METHODS

This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess < 300 cm3 were treated with drugs alone. Group B patients with abscess > 300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications.

RESULTS

There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group.

CONCLUSIONS

Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

背景

阿米巴肝脓肿在巴基斯坦是一个严重的问题。其治疗方法包括使用抗菌药物、针吸术和手术引流。本研究旨在观察超声引导下针吸术联合抗阿米巴药物治疗阿米巴肝脓肿的疗效、安全性及预后。

方法

这是一项前瞻性研究，对阿米巴肝脓肿患者进行至少六个月的随访，比较针吸术加抗阿米巴药物与单纯药物治疗的结果。研究于1998年7月至2001年6月在阿尤布教学医院外科B病房进行。患者分为两组。A组脓肿体积<300 cm³，仅接受药物治疗。B组脓肿体积>300 cm³或对药物治疗无反应的较小脓肿患者，接受针吸术和药物治疗。主要观察指标为腹痛、发热、厌食、肝肿大、超声检查显示阿米巴肝脓肿的消退情况、住院时间及任何并发症。

结果

研究组共有46例患者。A组21例（45.5%），B组25例（54.5%）。年龄范围为15至70岁。男性38例，女性8例。44例（95.5%）患者右叶受累，2例（4.5%）患者左叶受累。A组脓肿平均体积为225 cm³，B组为560 cm³。24例（96.3%）患者针吸术成功，1例（3.7%）患者失败。A组和B组临床改善的平均时间分别为7天和3天。B组平均住院时间（3.5天）短于A组（7.5天）。B组超声检查显示脓肿消退迅速。B组仅1例患者出现并发症。两组均未出现死亡病例。