Vögtlin J, Büche D, Gyr K
Schweiz Med Wochenschr. 1986 Aug 30;116(35):1166-72.
27 patients who presented with pyogenic liver abscess from 1957 to 1984 are analyzed retrospectively and compared with the literature. Diagnosis and start of therapy were frequently delayed because of the unspecificity of symptoms. Symptoms included fever, abdominal pain, weakness, and loss of weight. In 50% of all patients, the abscess was found by chance at laparotomy or autopsy. The most frequent causes of abscess formation were cholestasis due to extrahepatic obstruction and intraabdominal infections. Frequently a predisposing condition such as carcinoma, diabetes mellitus or alcohol abuse was found. The overall mortality was 25%, and was higher in patients with multiple abscesses of the liver (36%) than in patients with solitary abscesses (10%). With the introduction of new imaging procedures (ultrasound, computer tomography), the abscesses can be punctured under view and the antibiotic therapy can be based on bacterial analysis. The causative bacterial organism could be identified by cultures of the abscess fluid and blood in up to 90%. The bacteria identified usually were identical to the intestinal flora. Using specific antibiotic therapy, surgical treatment is often unnecessary and can be reserved for abscesses resistant to conservative treatment and for those due to correction of the original source of abscess formation.
对1957年至1984年间出现化脓性肝脓肿的27例患者进行回顾性分析，并与文献进行比较。由于症状不具特异性，诊断和治疗开始时间常常延迟。症状包括发热、腹痛、虚弱和体重减轻。在所有患者中，50%是在剖腹手术或尸检时偶然发现脓肿的。脓肿形成的最常见原因是肝外梗阻引起的胆汁淤积和腹腔内感染。经常发现有诸如癌症、糖尿病或酗酒等易感因素。总体死亡率为25%，肝多发性脓肿患者（36%）的死亡率高于单发脓肿患者（10%）。随着新的成像技术（超声、计算机断层扫描）的引入，可以在直视下对脓肿进行穿刺，抗生素治疗可以基于细菌分析。通过脓肿液和血液培养，高达90%的病例能够鉴定出致病细菌。鉴定出的细菌通常与肠道菌群相同。采用特异性抗生素治疗，通常无需手术治疗，手术可保留用于对保守治疗耐药的脓肿以及因纠正脓肿形成的原始病因所致的脓肿。
