Zhang Jia, Du Zhaoqing, Bi Jianbin, Wu Zheng, Lv Yi, Zhang Xufeng, Wu Rongqian
National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine.
Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering.
Medicine (Baltimore). 2018 Sep;97(39):e12290. doi: 10.1097/MD.0000000000012290.
Many pyogenic liver abscess (PLA) patients underwent abdominal surgery before. However, little is known about the impact of previous abdominal surgery on the clinical characteristics and prognosis of PLA.The clinical data of 392 adult PLA patients who received treatment at our hospital from January 1, 2007 to December 31, 2016 were collected. The demographic data, cause, comorbidities, surgery history, clinical features, laboratory results, imaging findings, microbiological characteristics, choices of treatment, and clinical outcomes were analyzed.In all, 177 PLA patients (45.2%) underwent abdominal surgery before. The median time for the occurrence of PLA after the most recent abdominal surgery was 2.0 (interquartile range 0.25, 6.0) years. PLA patients with a previous abdominal surgery history were more likely to have underlying diseases and presented with more abnormal laboratory values. Klebsiella pneumonia and Escherichia coli were the most common pathogens. Previous abdominal surgery appeared to increase the incidence of E coli. More PLA patients without a previous abdominal surgery history required surgical drainage. However, there were no differences in PLA-related complications, days required for temperature normalization, and length of hospital stay between the 2 groups.Because a large number of PLA patients had a history of abdominal surgery, and proper screening should be performed for patients with any suspicion of a liver abscess after abdominal surgery. Despite the differences in the coexisting conditions, clinical and microbiological characteristics between PLA patients with and without a previous abdominal surgery history, the overall short-term outcomes were comparable.
许多化脓性肝脓肿（PLA）患者既往接受过腹部手术。然而，关于既往腹部手术对PLA临床特征及预后的影响，人们知之甚少。收集了2007年1月1日至2016年12月31日在我院接受治疗的392例成年PLA患者的临床资料。对人口统计学数据、病因、合并症、手术史、临床特征、实验室检查结果、影像学表现、微生物学特征、治疗选择及临床结局进行了分析。总共有177例（45.2%）PLA患者既往接受过腹部手术。最近一次腹部手术后发生PLA的中位时间为2.0年（四分位间距0.25，6.0）。有腹部手术史的PLA患者更易患有基础疾病，实验室检查值异常更多见。肺炎克雷伯菌和大肠埃希菌是最常见的病原体。既往腹部手术似乎增加了大肠埃希菌的感染率。更多无腹部手术史的PLA患者需要手术引流。然而，两组在PLA相关并发症、体温恢复正常所需天数及住院时间方面并无差异。由于大量PLA患者有腹部手术史，对于腹部手术后任何怀疑肝脓肿的患者均应进行适当筛查。尽管有、无腹部手术史的PLA患者在并存疾病、临床及微生物学特征方面存在差异，但总体短期结局相当。
