Bayraktar Y, Arslan S, Sivri B, Eryilmaz M, Akova M, Van Thiel D H, Kayhan B
Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey.
Hepatogastroenterology. 1996 May-Jun;43(9):620-6.
BACKGROUND/AIMS: Surgical drainage of pyogenic and amoebic hepatic abscesses has been an accepted therapy for decades. Modern imaging modalities have changed both the diagnostic and therapeutic management of many hepatic lesions, particularly abscesses. Specifically, percutaneous aspiration and drainage with either ultrasound or computed tomography guidance has been reported as an alternative treatment for hepatic abscesses in recent years. Little is known about aspiration of hepatic abscesses that communicate with the biliary tree.
Fifteen patients with hepatic abscesses treated by percutaneous aspiration and drainage are herein reported. Six had a demonstrable fistulous communication between the abscess and the biliary tree.
During a four year period of follow-up, only two of these 15 patients experienced a recurrence. Neither had a biliary fistula complicating their abscess initially.
Based upon this experience, it is suggested that percutaneous aspiration and drainage should be the initial treatment of choice of both pyogenic and amoebic liver abscesses even when large. Abscesses with demonstratable biliary fistulas have a larger mean volume than do those without fistulous involvement. The finding of a communication between the abscess and the biliary tree should not change this treatment approach.
背景/目的：几十年来，化脓性和阿米巴性肝脓肿的手术引流一直是公认的治疗方法。现代成像方式改变了许多肝脏病变，特别是脓肿的诊断和治疗管理。具体而言，近年来已报道在超声或计算机断层扫描引导下进行经皮穿刺抽吸和引流作为肝脓肿的替代治疗方法。对于与胆道相通的肝脓肿的穿刺抽吸了解甚少。
本文报道了15例经皮穿刺抽吸和引流治疗的肝脓肿患者。其中6例脓肿与胆道之间存在明显的瘘管相通。
在四年的随访期间，这15例患者中只有2例复发。最初两者均无胆瘘并发脓肿。
基于这一经验，建议即使肝脓肿很大，经皮穿刺抽吸和引流也应作为化脓性和阿米巴性肝脓肿的首选初始治疗方法。有明显胆瘘的脓肿平均体积比无瘘管累及的脓肿大。脓肿与胆道之间存在相通的情况不应改变这种治疗方法。
