Tan Yu-Meng, Chung Alexander Yaw-Fui, Chow Pierce Kah-Hoe, Cheow Peng-Chung, Wong Wai-Keong, Ooi London Lucien, Soo Khee-Chee
From the Department of Surgery, Singapore General Hospital Department of Surgical Oncology, National Cancer Center, Singapore.
Ann Surg. 2005 Mar;241(3):485-90. doi: 10.1097/01.sla.0000154265.14006.47.
To determine whether first-line treatment with percutaneous or surgical drainage of liver abscesses larger than 5 cm results in better clinical outcome.
Pyogenic liver abscesses larger than 5 cm are currently treated by intravenous antibiotics and either percutaneous (PD) or surgical drainage (SD). Percutaneous techniques have been increasingly performed in place of open drainage as first-line treatment. This paradigm shift has been fueled by the drive for low-risk and less-invasive procedures and the surgical option being reserved for percutaneous failures. Yet there is a lack of data to support percutaneous drainage over open surgical drainage as first-line treatment.
Over a 3-year period, 80 patients with liver abscesses larger than 5 cm amenable to PD and SD were included in the study. This situation was possible as 1 team of surgeons favored the use of PD and 1 team favored the use of SD as first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence of fever, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality.
PD was performed in 36 patients and SD in 44 patients as first-line treatment. Clinical, laboratory, and abscess parameters were comparable in both groups. Sixty-four of 80 patients (80%) had multiloculated abscess. The time to defervescence of fever was not statistically significant (PD versus SD, 4.85 versus 4.38 days; P = 0.09). However, SD had less treatment failures (3 versus 10, P = 0.013), less requirement for secondary procedures (5 versus 13, P = 0.01), and shorter length of hospital stay (8 versus 11 days, P = 0.03). There was no difference in morbidity or mortality rates.
The results of our study show that for large liver abscesses more than 5 cm, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment of large liver abscesses.
确定对直径大于5 cm的肝脓肿采用经皮或手术引流作为一线治疗方法是否能带来更好的临床疗效。
目前，直径大于5 cm的化脓性肝脓肿采用静脉抗生素治疗，并结合经皮引流（PD）或手术引流（SD）。经皮技术已越来越多地取代开放引流作为一线治疗方法。这种模式的转变是由对低风险和微创程序的追求以及将手术选择保留用于经皮引流失败的情况所推动的。然而，缺乏数据支持经皮引流优于开放手术引流作为一线治疗方法。
在3年期间，80例直径大于5 cm且适合PD和SD的肝脓肿患者纳入研究。由于1组外科医生倾向于使用PD，而另1组倾向于使用SD作为一线治疗方法，所以这种情况是可能的。比较两组的治疗结果，临床终点包括发热退热时间、治疗失败、二次手术、住院时间、发病率和死亡率。
36例患者接受PD作为一线治疗，44例患者接受SD作为一线治疗。两组的临床、实验室和脓肿参数具有可比性。80例患者中有64例（80%）为多房性脓肿。发热退热时间无统计学差异（PD组与SD组，4.85天对4.38天；P = 0.09）。然而，SD组治疗失败较少（3例对10例，P = 0.013），二次手术需求较少（5例对13例，P = 0.01），住院时间较短（8天对11天，P = 0.03）。发病率和死亡率无差异。
我们的研究结果表明，对于直径大于5 cm的大肝脓肿，在治疗成功率、二次手术次数和住院时间方面，SD比PD具有更好的临床疗效，且发病率和死亡率相当。SD应被视为大肝脓肿的一线治疗方法。
