Nosher J L, Giudici M, Needell G S, Brolin R E
Dept. of Radiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Am Surg. 1993 Oct;59(10):658-63.
During the past 10 years, 15 patients have had percutaneous catheter drainage (PCD) of pyogenic liver abscesses (PLA) at a major teaching hospital. Five PLA were related to biliary tract disease, two were secondary to colonic diverticulitis, two developed after abdominal surgery, and the remaining were associated with hepatic trauma, gastric ulcer, Crohn's ileitis, and colon cancer. Two abscesses were cryptogenic. Mean diameter of PLA was 8 cm and ranged from 2-14 cm. Three patients had multiple PLA. All patients were initially treated by PCD without major complications. However, one patient required a second PCD after developing a recurrent abscess. Fever and leukocytosis defervesced at a mean 3.6 days and 7 days, respectively, after PCD. Seven of the 15 patients subsequently had one-stage elective abdominal operations for treatment of diseases underlying PLA including two cholecystectomies, two colon resections, one gastrectomy, one ileostomy closure, and one laparotomy for unresectable gall bladder cancer. There were no postoperative complications. These results demonstrate that PLA are best treated by using PCD as primary treatment with surgical drainage reserved for patients who do not respond clinically to PCD. The need for operative treatment in diseases underlying PLA should not deter use of PCD as primary treatment.
在过去10年里，一家大型教学医院有15例患者接受了化脓性肝脓肿（PLA）的经皮导管引流（PCD）治疗。5例PLA与胆道疾病有关，2例继发于结肠憩室炎，2例在腹部手术后发生，其余与肝外伤、胃溃疡、克罗恩回肠炎和结肠癌有关。2例脓肿病因不明。PLA的平均直径为8 cm，范围在2 - 14 cm之间。3例患者有多个PLA。所有患者最初均接受PCD治疗，无重大并发症。然而，1例患者在出现复发性脓肿后需要再次进行PCD治疗。PCD治疗后，发热和白细胞增多分别平均在3.6天和7天后消退。15例患者中有7例随后接受了一期择期腹部手术，以治疗PLA的潜在疾病，包括2例胆囊切除术、2例结肠切除术、1例胃切除术、1例回肠造口关闭术和1例因不可切除胆囊癌进行的剖腹手术。无术后并发症。这些结果表明，PLA最好的治疗方法是以PCD作为主要治疗手段，手术引流仅用于对PCD无临床反应的患者。PLA潜在疾病的手术治疗需求不应妨碍将PCD作为主要治疗方法的使用。
