Memon A S, Siddiqui F G, Memon H A, Ali S A
Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
J Ayub Med Coll Abbottabad. 2010 Apr-Jun;22(2):96-9.
Amoebiasis affects approximately 10% of the population all over the world. Amoebic liver abscess (ALA) is the commonest complication of amoebiasis affecting 3-9% victims. It is an ancient disease as Hippocrates notified large hepatic abscesses likely to be amoebic abscesses. Objective of this study was to see the efficacy of conservative treatment in the management of ruptured amoebic liver abscess.
Record of 1,083 patients of amoebic liver abscess, who were treated and managed at Liaquat University Hospital between January 1986 and December 2007, was reviewed retrospectively. Amongst these, 36 (3.32%) patients, found to have intra-peritoneal rupture of the liver abscess were included in this study. The record of these patients was reviewed. The patients were divided into group A and B depending upon the mode of treatment employed. Group A included 16 (44.44%) patients in whom exploratory laparotomy was performed while group B included 20 (55.55%) patients who were treated conservatively.
Group A consisted of 16 (44.4%) patients who underwent laparotomy for acute peritonitis due to non-availability of ultrasound in the initial period of the study. In group B, all twenty patients were treated conservatively after a diagnosis of ruptured amoebic liver abscess made by ultrasound guided percutaneous aspiration of pus. These patients were treated with ultrasound guided aspiration of pus with placement of peritoneal drain under local anaesthesia. Six patients in group A died compared to one patient in group B. the overall mortality of ruptured amoebic liver abscess was 19.4%. It was higher in patients treated surgically (37.5%) compared to patients who were treated conservatively (5%).
Conservative treatment is an effective modality of treatment for ruptured liver abscess with minimum mortality and mortality if diagnosis is made early.
阿米巴病影响着全球约10%的人口。阿米巴肝脓肿（ALA）是阿米巴病最常见的并发症，影响3%-9%的患者。这是一种古老的疾病，因为希波克拉底曾提到过大的肝脓肿可能是阿米巴脓肿。本研究的目的是观察保守治疗在破裂性阿米巴肝脓肿管理中的疗效。
回顾性分析了1986年1月至2007年12月在利亚卡特大学医院接受治疗和管理的1083例阿米巴肝脓肿患者的记录。其中，36例（3.32%）被发现有肝脓肿腹腔内破裂的患者被纳入本研究。对这些患者的记录进行了回顾。根据所采用的治疗方式，将患者分为A组和B组。A组包括16例（44.44%）患者，他们接受了剖腹探查术，而B组包括20例（55.55%）接受保守治疗的患者。
A组由16例（44.4%）患者组成，他们因研究初期无法获得超声而接受剖腹手术治疗急性腹膜炎。在B组中，所有20例患者在超声引导下经皮穿刺抽脓诊断为破裂性阿米巴肝脓肿后均接受保守治疗。这些患者在局部麻醉下接受超声引导下的抽脓并放置腹腔引流管。A组有6例患者死亡，而B组有1例患者死亡。破裂性阿米巴肝脓肿的总体死亡率为19.4%。手术治疗患者的死亡率（37.5%）高于保守治疗患者（5%）。
保守治疗是治疗破裂性肝脓肿有效的方法，早期诊断可使死亡率降至最低。
