Pitt H A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
World J Surg. 1990 Jul-Aug;14(4):498-504. doi: 10.1007/BF01658675.
Amebic and pyogenic hepatic abscesses are rare liver lesions that may require surgical intervention. Amebic liver abscesses are more common in subtropical and tropical climates and in areas with poor sanitation. The majority of pyogenic liver abscesses are caused by infections in the biliary or intestinal tracts. These lesions can be differentiated on clinical grounds and by amebic serology. Ultrasound and computed tomography are the imaging techniques of choice. The initial management of amebic hepatic abscesses is treatment with amebicidal agents. Most patients respond rapidly so that surgery is reserved for patients with complications including secondary bacterial infection, impending rupture, or rupture into the pericardium or peritoneum. Patients with pyogenic hepatic abscesses require a prolonged course of antibiotics and appropriate drainage. Selected solitary abscesses can be managed with percutaneous abscess drainage. Similarly, some abscesses of biliary origin will respond to percutaneous biliary drainage. Surgical drainage has several advantages including: the ability to explore the abdomen for a source, excellent exposure of the entire liver, accurate assessment, sometimes with ultrasound, of the best drainage site, and access to the biliary tree for cholangiography and drainage.
阿米巴肝脓肿和化脓性肝脓肿是罕见的肝脏病变，可能需要手术干预。阿米巴肝脓肿在亚热带和热带气候以及卫生条件差的地区更为常见。大多数化脓性肝脓肿由胆道或肠道感染引起。这些病变可根据临床情况和阿米巴血清学进行鉴别。超声和计算机断层扫描是首选的成像技术。阿米巴肝脓肿的初始治疗是使用杀阿米巴药物。大多数患者反应迅速，因此手术仅适用于有并发症的患者，包括继发性细菌感染、即将破裂或破入心包或腹膜。化脓性肝脓肿患者需要长期使用抗生素并进行适当引流。部分孤立性脓肿可通过经皮脓肿引流进行处理。同样，一些源于胆道的脓肿对经皮胆道引流有反应。手术引流有几个优点，包括：能够探查腹部寻找病因、能很好地暴露整个肝脏、可准确评估（有时借助超声）最佳引流部位，以及能够进入胆道进行胆管造影和引流。
