Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
Eur J Radiol. 2010 Apr;74(1):195-8. doi: 10.1016/j.ejrad.2009.01.017. Epub 2009 Feb 12.
BACKGROUND/AIMS: To study the morphology of residual abscess in successfully treated pyogenic liver abscess by ultrasound.
116 consecutive patients of liver abscess diagnosed from April 2004 to March 2007 were included in this study. Patients with amebic liver abscess were excluded. Patients were treated with antibiotics for 6 weeks and when indicated drained percutaneously. Ultrasound scan was repeated after 2 weeks, 1 month, 3 months, 6 months and 12 months of treatment. Thereafter it was repeated every 6 months.
After exclusion, 102 patients with >150 lesions were studied. Diagnosis was made on the basis of clinical presentation, ultrasound examination and diagnostic aspiration. It was single in 83, double in 12 and more than 2 in seven patients. Size varied from 4.2cm to 15cm. Organisms were isolated in 29 patients (E. coli 10, Kliebsiella sp. 6, S. aureus 5, Pseudomonas aeruginosa 2, Acenetobacter 1 and multiple growth 5) in blood and eight patients (E. coli 5 and S. aureus 3 and multiple growth 2) in pus. Majority of abscess resolved sonologically after 2-18 weeks of treatment. Healing was delayed in alcoholic and diabetic patients. In eight patients there was residual abscess even after 104 weeks of follow-up. In four patients it healed with calcification.
Majority of pyogenic liver abscess resolve to normal parenchyma within 18 weeks time. However, some lesions may take longer time to heal even after successful treatment. It should be considered in differential diagnosis of space occupying lesion of the liver in ultrasound and need no therapeutic intervention.
背景/目的：通过超声研究成功治疗的化脓性肝脓肿中残余脓肿的形态。
本研究纳入了 2004 年 4 月至 2007 年 3 月期间连续 116 例肝脓肿患者。排除阿米巴性肝脓肿患者。患者接受抗生素治疗 6 周，如有必要则经皮引流。治疗后 2 周、1 个月、3 个月、6 个月和 12 个月重复超声扫描。此后，每 6 个月重复一次。
排除后，对 102 例>150 个病变的患者进行了研究。诊断基于临床症状、超声检查和诊断性抽吸。83 例为单发，12 例为双发，7 例为多发。大小从 4.2cm 到 15cm 不等。29 例患者（大肠杆菌 10 例，克雷伯菌属 6 例，金黄色葡萄球菌 5 例，铜绿假单胞菌 2 例，不动杆菌 1 例，混合生长 5 例）在血液中分离出病原体，8 例患者（大肠杆菌 5 例，金黄色葡萄球菌 3 例，混合生长 2 例）在脓液中分离出病原体。大多数脓肿在治疗后 2-18 周内超声表现完全消退。酒精和糖尿病患者的愈合时间延长。8 例患者即使在 104 周的随访后仍有残余脓肿。其中 4 例在钙化后愈合。
大多数化脓性肝脓肿在 18 周内可恢复正常肝实质。然而，一些病变即使在成功治疗后也需要更长的时间才能愈合。在超声诊断肝脏占位性病变时应考虑到这一点，且无需进行治疗性干预。
