Muorah M, Hinds R, Verma A, Yu D, Samyn M, Mieli-Vergani G, Hadzić N
Department of Child Health, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
J Pediatr Gastroenterol Nutr. 2006 Feb;42(2):201-6. doi: 10.1097/01.mpg.0000189344.23387.26.
The aim of this study was to investigate the clinical and radiologic features, predisposing risk factors, and complications of children with pyogenic liver abscess (PLA) referred to a tertiary pediatric hepatology center.
We analyzed our database of all children referred to our unit over a 10 year period and performed a case note review of all patients with a radiologically proven PLA.
PLA was diagnosed in 15 children (7 boys), 0.5% of all referrals. They presented at a median age of 10 years (range 2 months-15 years). In three children (2 boys), PLA was the first manifestation of chronic granulomatous disease. Among the others, five had radiologic evidence of other intra-abdominal pathology (1 with subsequently proven appendicitis), and four developed portal vein thrombosis with portal hypertension. The commonest isolated pathogen was Staphylococcus aureus. Combined treatment with guided aspiration and prolonged intravenous antibiotics was successful in all patients.
PLA is a rare diagnosis in children in the developed world. It may be caused by primary neutrophil disorders even in the absence of a previous history of infection. Co-existent appendicitis, intra-abdominal sepsis, and ascending pylephlebitis must be sought because these children are at risk of developing portal vein obstruction and portal hypertension. Prolonged intravenous antibiotic treatment guided by microbiologic sensitivities is highly effective.
本研究旨在调查转诊至一家三级儿科肝病中心的化脓性肝脓肿（PLA）患儿的临床和放射学特征、易感危险因素及并发症。
我们分析了10年间转诊至我科的所有患儿的数据库，并对所有经放射学证实为PLA的患者进行了病例记录回顾。
15名儿童（7名男孩）被诊断为PLA，占所有转诊患者的0.5%。他们的中位年龄为10岁（范围2个月至15岁）。在3名儿童（2名男孩）中，PLA是慢性肉芽肿病的首发表现。在其他患儿中，5名有其他腹部内病变的放射学证据（1名随后被证实为阑尾炎），4名发生门静脉血栓形成并伴有门静脉高压。最常见的分离病原体是金黄色葡萄球菌。所有患者采用引导性穿刺和延长静脉抗生素联合治疗均获成功。
在发达国家，PLA在儿童中是一种罕见的诊断。即使没有既往感染史，它也可能由原发性中性粒细胞疾病引起。必须寻找并存的阑尾炎、腹部内脓毒症和上行性门静脉炎，因为这些患儿有发生门静脉梗阻和门静脉高压的风险。根据微生物敏感性进行延长静脉抗生素治疗非常有效。
