Heo Nae Yun, Hong Young Mi, Kim Tae Oh, Moon Young Soo, Yang Sung Yeun, Park Seung Ha, Park Jongha, Choi Joon Hyuk, Kim Sung Min, Yoon Ki Tae, Cho Mong, Oh Minkyung
Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
Korean J Gastroenterol. 2016 Oct 25;68(4):195-201. doi: 10.4166/kjg.2016.68.4.195.
BACKGROUND/AIMS: Several studies suggest that pyogenic liver abscess (PLA) is associated with colon neoplasm. A colonoscopic exam for cryptogenic PLA might detect a hidden colon neoplasm, through which intestinal flora can be transmitted into the liver. However, there are no prospectively enrolled cross-sectional data for colonic neoplasm in cryptogenic PLA.
Patients with PLA were prospectively enrolled from two university hospitals. Among them, all the patients with cryptogenic PLA were recommended for colonoscopic exam to check for colonic neoplasm.
One hundred eighty-three patients with PLA were enrolled in the study for 22 months. One hundred and one (55.2%) patients did not have a definite cause of liver abscess at initial evaluation. The median diameter of the largest lesion was 5.7 cm (1.0-14.0 cm), and 74.3% of the patients were treated by percutaneous abscess drainage. Ninety-one percent of the patients who had an identified pathogen yielded Klebsiella. Sixty-two patients underwent colonoscopic exams, and no one had a colonic cancer, one had an adenomatous polyp with high grade dysplasia (1.6%), and 27 had adenomatous polyps with low grade dysplasia (43.5%; 41.0% in male and 43.5% in female). Of fifty patients who underwent an esophagogastroduodenoscopic exam, nine had gastric ulcers, one had an esophageal ulcer, and one had hemorrhagic gastritis.
The prevalence of colonic neoplasm among the patients with cryptogenic PLA was not as high as that in previous studies. Further well-designed, large-scale studies are required to assess the association of the colon neoplasm and cryptogenic PLA.
背景/目的：多项研究表明，化脓性肝脓肿（PLA）与结肠肿瘤有关。对于隐源性PLA进行结肠镜检查可能会发现隐匿的结肠肿瘤，借此肠道菌群可传播至肝脏。然而，目前尚无关于隐源性PLA中结肠肿瘤的前瞻性纳入横断面数据。
从两家大学医院前瞻性纳入PLA患者。其中，所有隐源性PLA患者均被建议进行结肠镜检查以排查结肠肿瘤。
183例PLA患者纳入研究22个月。101例（55.2%）患者在初始评估时无明确的肝脓肿病因。最大病灶的中位直径为5.7 cm（1.0 - 14.0 cm），74.3%的患者接受了经皮脓肿引流治疗。91%的已鉴定出病原体的患者培养出肺炎克雷伯菌。62例患者接受了结肠镜检查，无人患有结肠癌，1例患有高级别异型增生的腺瘤性息肉（1.6%），27例患有低级别异型增生的腺瘤性息肉（43.5%；男性为41.0%，女性为43.5%）。在50例接受食管胃十二指肠镜检查的患者中，9例有胃溃疡，1例有食管溃疡，1例有出血性胃炎。
隐源性PLA患者中结肠肿瘤的患病率低于以往研究。需要进一步设计良好的大规模研究来评估结肠肿瘤与隐源性PLA之间的关联。
