Jindal Ankur, Pandey Apurva, Sharma Manoj K, Mukund Amar, Vijayaraghavan Rajan, Arora Vinod, Shasthry Saggere M, Choudhary Ashok, Sarin Shiv K
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
J Clin Exp Hepatol. 2021 May-Jun;11(3):312-320. doi: 10.1016/j.jceh.2020.10.002. Epub 2020 Oct 15.
The management practices of liver abscess (LA) have evolved over time. The precise diagnosis of etiology and complications is pivotal for appropriate management.
Descriptive analyses of consecutive patients treated for LA using electronic medical records at a liver unit between years 2010 and 2020 and investigate relationships between clinical, imaging, laboratory and microbiological findings, treatment strategies and mortality.
Of 1630 LA patients, the most common aetiologies were amoebic liver abscess (ALA; 81%) and pyogenic liver abscess (PLA; 10.3%, mainly related to biliary disease and/or obstruction). Abdominal pain (86%) and fever (85.3%) were the commonest presenting symptoms (median duration-10 days). Almost 10% had jaundice at presentation, 31.1% were diabetic, 35.5% had chronic alcohol use and 3.3% had liver cirrhosis. Nearly 54% LA were solitary, 77.7% localized to the right liver lobe (most commonly segment VII/VIII). Patients with large LA (>10 cm, 11.9%) had more frequent jaundice and abscess rupture (p-0.01). Compared with ALA, patients with PLA were older, more often had multiple and bilobar abscesses with local complications. Over four-fifth of the patients received percutaneous interventions (catheter drainage [PCD; 36.1%] alone and needle aspiration [PNA] plus PCD [34.1%] as most common). Fifty-eight patients underwent endoscopic retrograde cholangiography for intrabiliary abscess rupture (n = 36) or cholangitic abscess (n = 22). The median duration of hospital stay and PCD were 7 (4-10) days and 5 (4-8 days), respectively. The overall in-hospital mortality was 1.1%. Presence of septic encephalopathy (HR: 20.8; 95% CI: 1.9-220.7; p-0.012), liver cirrhosis (HR: 20.1; 95% CI: 2.7-146.9; p-0.003) and jaundice (HR: 7.6; 95% CI:1.7-33.1; p-0.006) were independent predictors of mortality.
The commonest presentation was middle age male with right lobe solitary ALA. Patients with large, bilobar and/or pyogenic abscess had more complications. Nearly 70% patients require percutaneous interventions, which if given early improve treatment outcomes. Presence of jaundice, liver cirrhosis and septic encephalopathy were independent predictors of mortality.
肝脓肿（LA）的管理方法随时间不断演变。病因和并发症的准确诊断对于恰当管理至关重要。
对2010年至2020年间在肝脏科使用电子病历治疗的连续性LA患者进行描述性分析，研究临床、影像、实验室和微生物学检查结果、治疗策略与死亡率之间的关系。
1630例LA患者中，最常见的病因是阿米巴肝脓肿（ALA；81%）和化脓性肝脓肿（PLA；10.3%，主要与胆道疾病和/或梗阻有关）。腹痛（86%）和发热（85.3%）是最常见的症状（中位持续时间为10天）。近10%的患者就诊时出现黄疸，31.1%患有糖尿病，35.5%有长期饮酒史，3.3%患有肝硬化。近54%的LA为单发，77.7%局限于右肝叶（最常见于VII/VIII段）。大LA（>10 cm，11.9%）患者黄疸和脓肿破裂更为常见（p = 0.01）。与ALA患者相比，PLA患者年龄更大，多发和双侧肝叶脓肿及局部并发症更为常见。超过五分之四的患者接受了经皮介入治疗（最常见的是单纯导管引流[PCD；36.1%]以及穿刺抽吸[PNA]加PCD[34.1%]）。58例患者因胆管内脓肿破裂（n = 36）或胆管炎相关性脓肿（n = 22）接受了内镜逆行胆管造影。住院时间和PCD的中位持续时间分别为7（4 - 10）天和5（4 - 8）天。总体住院死亡率为！.1%。存在感染性脑病（HR：20.8；95%CI：1.9 - 220.7；p = 0.012）、肝硬化（HR：20.1；95%CI：2.7 - 146.9；p = 0.003）和黄疸（HR：7.6；95%CI：1.7 - 33.1；p = 0.006）是死亡率的独立预测因素。
最常见的表现是中年男性右叶单发ALA。大的、双侧肝叶和/或化脓性脓肿患者并发症更多。近70%的患者需要经皮介入治疗，早期进行可改善治疗效果。黄疸、肝硬化和感染性脑病的存在是死亡率的独立预测因素。
