斐济的阿米巴性肝脓肿：流行病学、临床表现以及经皮抽吸与经皮置管引流的比较。

Amoebic Liver Abscesses in Fiji: Epidemiology, Clinical Presentation and Comparison of Percutaneous Aspiration and Percutaneous Catheter Drainage.

机构信息

Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.

Nepean Clinical School, Nepean Hospital, The University of Sydney, Clinical Sciences Building, P. O. Box 67, Penrith, NSW, 2751, Australia.

出版信息

World J Surg. 2020 Mar;44(3):665-672. doi: 10.1007/s00268-019-05274-7.

DOI:10.1007/s00268-019-05274-7

PMID:31712845

Abstract

BACKGROUND

Amoebic liver abscess (ALA) is a common clinical problem in tropical countries related to poor sanitation. The epidemiology and clinical presentation of ALA in Fiji has not been previously described. It is unclear whether percutaneous aspiration (PA) or percutaneous catheter drainage (PCD) has better outcomes.

PURPOSE

The aims were to describe the epidemiology and clinical presentation of ALA in Fiji and to compare the outcomes of PA and PCD for treatment of ALA.

METHODS

A retrospective case note review of patients treated with either PA or PCD between 2010 and 2015 was performed. Indications for intervention were ALA > 5 cm, ALA in the left lateral lobe, risk of imminent rupture and failure to respond to medical treatment.

RESULTS

There were 262 patients, 90% were male, 92.9% I-Taukei ethnicity and 86.2% regular recreational kava drinkers. Most presented with upper abdominal pain and fevers. The majority (90.3%) had a single abscess with 87.8% being in the right lobe. 174 (66.4%) had LA and 88 (33.6%) had PCD. There was an unintended selection bias for PA in abscess with a volume of <1 litre. PA was associated with a more rapid resolution of fever and shorter hospital stay, more rapid resolution of the cavity and no morbidity. PCD had five complications, one bleed and four bile leaks. There was no mortality in either group.

CONCLUSIONS

ALA in Fiji occurs in I-Taukei males who drink kava. PA appears to offer equivalent if not better outcomes for treatment of ALA.

摘要

背景

阿米巴肝脓肿（ALA）是与卫生条件差有关的热带国家常见的临床问题。斐济的 ALA 流行病学和临床表现以前尚未描述过。尚不清楚经皮抽吸（PA）还是经皮导管引流（PCD）的效果更好。

目的

本研究旨在描述斐济的 ALA 的流行病学和临床表现，并比较 PA 和 PCD 治疗 ALA 的结果。

方法

对 2010 年至 2015 年间接受 PA 或 PCD 治疗的患者进行回顾性病历审查。干预的适应证为 ALA>5cm，ALA 位于左外侧叶，有即将破裂的风险以及对药物治疗无反应。

结果

共有 262 例患者，90%为男性，92.9%为 I-Taukei 族裔，86.2%为经常饮用卡瓦的人。大多数患者表现为上腹痛和发热。大多数（90.3%）有单个脓肿，87.8%位于右叶。174 例（66.4%）有 LA，88 例（33.6%）有 PCD。脓肿体积<1 升时，PA 存在非预期的选择偏倚。PA 与发热更快缓解和住院时间更短、更快地使脓肿腔缩小和无并发症相关。PCD 有 5 种并发症，1 例出血和 4 例胆漏。两组均无死亡病例。