Shimada H, Ohta S, Maehara M, Katayama K, Note M, Nakagawara G
First Department of Surgery, Fukui Medical School, Japan.
Int Surg. 1993 Jan-Mar;78(1):40-5.
The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.
26例化脓性肝脓肿的感染途径及病因如下：门静脉播散1例，血行感染3例，胆道感染12例，经动脉栓塞术（TAE）3例，肝切除术后1例，隐源性5例。门静脉和血行感染病例在超声检查中倾向于表现为单发和囊性，检测到的细菌多数为克雷伯菌。而大多数胆道感染病例在超声检查中表现为多发和囊性伴肿瘤样，CT特征为不均匀低密度，仅在胆道或TAE病例中分离出厌氧菌和念珠菌。大多数病例通过各种脓肿引流可完全治愈，但2例TAE病例行经皮肝穿刺脓肿引流（PTAD）以及2例胆道感染病例行经皮肝穿刺胆道引流（PTBD）和PTAD后，因诊断延误和病情严重而死亡。早期诊断并随后行PTAD或PTBD被认为至关重要。
