Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi Province, 710068, China.
Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China.
BMC Infect Dis. 2024 May 10;24(1):479. doi: 10.1186/s12879-024-09378-x.
BACKGROUND & AIMS: Pyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS).
The study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group (n = 91) and the non-BS group (n = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n = 22) and non-bilioenteric anastomoses group (non-BEA, n = 69). Clinical characteristics were recorded and analyzed.
The percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities (P = 0.009 and P = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus (P < 0.001) and solitary abscesses (P = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures (P = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history (P = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%).
Patients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.
化脓性肝脓肿（PLA）是一种常见的肝胆感染，其发病率呈上升趋势，胆道手术被认为是其诱因。本研究旨在探讨有和无胆道手术（BS）史的 PLA 患者的临床特征和治疗方法。
本研究共纳入 2014 年 1 月至 2023 年 2 月在我院接受治疗的 353 例 PLA 患者，将其分为 BS 组（n=91）和非 BS 组（n=262）。BS 组根据吻合方式进一步分为胆肠吻合组（BEA，n=22）和非胆肠吻合组（非 BEA，n=69）。记录并分析患者的临床特征。
有 BS 史的 PLA 患者占 25.78%。BS 组患者的 TBIL 和活化 APTT 异常水平升高（P=0.009 和 P=0.041）。BS 组中，BEA 亚组糖尿病（P<0.001）和单发性脓肿（P=0.008）的发生率高于非 BEA 亚组。BS 组中阳性脓液培养的大肠埃希菌检出率较高（P=0.021）。BS 组的治疗效果低于无 BS 史组（P=0.020）。有趣的是，BS 组接受保守治疗的比例较高（45.05% vs. 21.76%），而手术引流的使用率较低（6.59% vs. 16.41%）。
有 BS 史的患者，尤其是接受 BEA 的患者，更容易发生 PLA，且不影响预后。
