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1例采用损伤控制策略挽救的肝脓肿高黏液血症表型病例

A Case of Hypermucoviscosity Phenotype of Liver Abscess Saved by Damage Control Strategy.

作者信息

Sato Keita, Takahashi Koji, Kusuta Tsukasa

机构信息

Department of Surgery, Ise Red Cross Hospital, Japan.

出版信息

Case Rep Surg. 2022 Sep 29;2022:6019866. doi: 10.1155/2022/6019866. eCollection 2022.

Abstract

Liver abscess caused by the Hypermucoviscosity phenotype of (HKp) is characterized by high tissue invasiveness and multiple systemic infections. This leads to sepsis, multiple organ failure, and coagulopathy. An 80 year old man came to our hospital with a complaint of malaise and went into hemorrhagic shock after percutaneous transhepatic drainage of a liver abscess caused by HKp. An emergency laparotomy was performed, but the patient suffered from severe coagulopathy and underwent damage control surgery. HKp liver abscesses must be operated on in the presence of multiple organ failure and disseminated intravascular coagulation (DIC) complications when medical treatment is refractory. In these situations, a two-stage damage control strategy should be considered: hemostasis and infection control at the initial surgery and hepatic resection.

摘要

高黏液性肺炎克雷伯菌(HKp)引起的肝脓肿具有高组织侵袭性和多种全身感染的特点。这会导致败血症、多器官功能衰竭和凝血病。一名80岁男性因身体不适前来我院就诊,在经皮肝穿刺引流由HKp引起的肝脓肿后发生出血性休克。进行了急诊剖腹手术,但患者患有严重凝血病,接受了损伤控制手术。当药物治疗无效时,HKp肝脓肿在出现多器官功能衰竭和弥散性血管内凝血(DIC)并发症的情况下必须进行手术。在这些情况下,应考虑采用两阶段损伤控制策略:初次手术时止血和控制感染,以及肝切除术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2270/9537032/f0e12b9d1cbd/CRIS2022-6019866.001.jpg

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