Pearce N W, Knight R, Irving H, Menon K, Prasad K R, Pollard S G, Lodge J P A, Toogood G J
Hepatobiliary Surgical Unit, St James's University Hospital Leeds West Yorkshire UK.
HPB (Oxford). 2003;5(2):91-5. doi: 10.1080/13651820310001126.
Liver abscess is a serious disease traditionally managed by open drainage. The advances in interventional radiology over the last two decades have allowed a change in approach to this condition. We have reviewed our experience in managing liver abscess over the last 7 years.
Details of all patients admitted with liver abscess between 1995 and 2002 were prospectively entered onto our database. A review was performed to document the use of imaging and drainage techniques. Aetiology, morbidity, mortality and duration of hospital stay were recorded.
Forty-two patients (median age 53 [22-85] years; M:F 18:24) were admitted with liver abscess (multiple abscess 20); 19 cases were of portal tract origin, 16 cases were of biliary tract origin and 7 cases were spontaneous. Forty-one patients were managed non-operatively, all received antibiotics (cephalosporins 76%, metronidazole 88%, quinolones 33%). Diagnosis was made on ultrasound scan (22) or CT (20). Five patients were managed with antibiotics alone. Fifteen patients were managed initially with percutaneous aspiration and five subsequently required percutaneous drainage. Twenty-one patients had primary percutaneous drainage, nine requiring a further procedure (aspiration 3, drainage 6). One patient underwent hepatic resection. Median hospital stay was 16 (6-35) days. There was one death, but no procedure-related morbidity.
Non-operative management of solitary and multiple liver abscesses is safe and effective.
肝脓肿是一种传统上通过开放引流进行治疗的严重疾病。过去二十年间介入放射学的进展使得对这种疾病的治疗方法发生了改变。我们回顾了过去7年中我们在治疗肝脓肿方面的经验。
前瞻性地将1995年至2002年间所有因肝脓肿入院的患者的详细信息录入我们的数据库。进行了一项回顾以记录成像和引流技术的使用情况。记录病因、发病率、死亡率和住院时间。
42例患者（中位年龄53[22 - 85]岁；男:女为18:24）因肝脓肿入院（多发脓肿20例）；19例源于门静脉，16例源于胆道，7例为自发性。41例患者接受了非手术治疗，所有患者均接受了抗生素治疗（头孢菌素76%，甲硝唑88%，喹诺酮类33%）。通过超声扫描（22例）或CT（20例）做出诊断。5例患者仅接受抗生素治疗。15例患者最初接受经皮穿刺抽吸，5例随后需要经皮引流。21例患者接受了初次经皮引流，9例需要进一步的操作（抽吸3例，引流6例）。1例患者接受了肝切除术。中位住院时间为16（6 - 35）天。有1例死亡，但无与操作相关的并发症。
孤立性和多发性肝脓肿的非手术治疗是安全有效的。
