Dulku Gurjeet, Mohan Geeta, Samuelson Shaun, Ferguson John, Tibballs Jonathan
Department of Radiology, Interventional Specials, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Australas Med J. 2015 Jan 31;8(1):7-18. doi: 10.4066/AMJ.2015.2240. eCollection 2015.
A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008-2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia.
Forty-two patients (29 males and 13 females; aged between 28-93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised.
Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups.
The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.
回顾2008年至2013年期间，澳大利亚一家三级医院查尔斯·盖尔德纳爵士医院不同操作人员分别采用经皮穿刺抽吸（PA）和导管引流（PCD）进行肝脓肿引流的有效性和结果。
42例肝脓肿患者（29例男性，13例女性；年龄在28 - 93岁之间；中位年龄67岁）接受了超声或CT引导下的PA（n = 22）和PCD（n = 20），并同时给予适当的抗菌治疗。分别使用了中位规格为18G的针和10F的导管。
19例（86.4%）PA病例和12例（60%）PCD病例一次穿刺成功引流（p = 0.08）。观察到男性患者（69%）多于女性患者（31%）。门静脉败血症（42.9%）是最常见的病因。发热（47.6%）是入院时最常见的临床表现。32例患者（76.2%）有单个脓肿，以右叶为主（59.5%）。CRP显著升高。PCD组脓肿尺寸明显更大（p = 0.01）。肺炎克雷伯菌是脓液（33.3%）和血培养（11.9%）中最常见的分离菌。记录到5例与操作相关的并发症，均发生在PCD组。30天死亡率为2.4%。两组在临床和治疗结果上未观察到差异。
PA和PCD在肝脓肿引流中同样有效的原假设不能被拒绝。除了PA操作更简单、更安全外，留置导管相关并发症的较高发生率表明应始终首先尝试PA。
