Yeh T S, Jan Y Y, Jeng L B, Hwang T L, Chao T C, Chien R N, Chen M F
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
Arch Surg. 1998 Mar;133(3):242-5. doi: 10.1001/archsurg.133.3.242.
Prognosis of pyogenic liver abscesses in patients with malignant disease is generally considered poor. The discrepancy between the outcomes of liver abscesses caused by hepatopancreatobiliary malignant disease and those caused by other malignant diseases, however, to our knowledge has never been investigated.
To clarify the clinical course of pyogenic liver abscess in patients with different types of cancer, and to compare outcomes in abscesses caused by hepatopancreatobiliary malignant disease and other malignant disease.
Retrospective review of case series in our experience from 1980 through 1993.
Tertiary care university teaching hospital.
Fifty-two patients with pyogenic liver abscess related to the underlying cancer were divided into 2 groups. Group 1 (n=32) was composed of patients with cancer originating from the hepatic parenchyma, bile duct, and pancreas; group 2 (n=20) was composed of patients with cancer originating from other sites.
Parenteral antibiotics, percutaneous drainage, surgical drainage, or hepatectomy, in combinations, were employed.
Patient characteristics, symptoms, laboratory data, abscess characteristics, microbiological study, management, and outcome of the 2 groups were analyzed.
Thirteen patients (41%) in group 1 and 16 patients (80%) in group 2 had undergone prior anticancer treatment. Jaundice was encountered more often in group 1 than in group 2 (29 patients [91%] vs 6 patients [30%], respectively, P=.001), whereas nausea and vomiting were more frequently seen in group 2 than in group 1 (17 patients [52%] vs 6 patients[31%], respectively, P=.04). Leukocytosis, hypoalbuminemia, hyperbilirubinemia, and reversed albumin-globulin ratio were more pronounced in group 1 than in group 2 (P=.001, .02, .003, and .03, respectively). Abscesses communicating with the intrahepatic biliary tree were more frequently encountered in group 1 than in group 2 (11 patients [34%] vs 2 patients [10%], respectively, P=.03). Escherichia coli and Klebsiella pneumoniae predominated in group 1, while the bacteria species in group 2 were more diverse. The hospital mortality rates of group 1 and group 2 were 28% (9 of 32 patients) vs 10% (2 of 20 patients) (P=.04), respectively. Twenty-three patients (72%) of group 1 died of uncontrolled biliary sepsis or progressive cancer or both within 6 months after the diagnosis, while 17 patients (85%) of group 2 survived longer than 1 year without relapse of the abscess and continued with anticancer treatment.
Pyogenic liver abscess could be a presentation of hepatopancreatobiliary malignant disease at the preterminal stage, and carries a grave prognosis. Pyogenic liver abscess in patients with nonhepatopancreatobiliary malignant disease has a better chance of favorable outcome.
恶性疾病患者发生的化脓性肝脓肿预后通常被认为较差。然而，据我们所知，肝胰胆恶性疾病引起的肝脓肿与其他恶性疾病引起的肝脓肿在治疗结果上的差异从未被研究过。
明确不同类型癌症患者化脓性肝脓肿的临床病程，并比较肝胰胆恶性疾病和其他恶性疾病引起的肝脓肿的治疗结果。
回顾性分析1980年至1993年我们收治的病例系列。
三级医疗大学教学医院。
52例与潜在癌症相关的化脓性肝脓肿患者被分为2组。第1组（n = 32）由起源于肝实质、胆管和胰腺的癌症患者组成；第2组（n = 20）由起源于其他部位的癌症患者组成。
采用静脉注射抗生素、经皮引流、手术引流或肝切除术等联合治疗。
分析两组患者的特征、症状、实验室数据、脓肿特征、微生物学研究、治疗方法及治疗结果。
第1组13例患者（41%）和第2组16例患者（80%）曾接受过抗癌治疗。第1组黄疸的发生率高于第2组（分别为29例[91%]和6例[30%]，P = 0.001），而第2组恶心和呕吐的发生率高于第1组（分别为17例[52%]和6例[31%]，P = 0.04）。第1组白细胞增多、低白蛋白血症、高胆红素血症和白蛋白 - 球蛋白比值倒置比第2组更明显（分别为P = 0.001、0.02、0.003和0.03）。第1组与肝内胆管树相通的脓肿比第2组更常见（分别为11例[34%]和2例[10%]，P = 0.03）。第1组以大肠杆菌和肺炎克雷伯菌为主，而第2组的细菌种类更多样化。第1组和第2组的医院死亡率分别为28%（32例患者中的9例）和10%（20例患者中的2例）（P = 0.04）。第1组23例患者（72%）在诊断后6个月内死于无法控制的胆源性败血症或进展性癌症或两者兼有，而第2组17例患者（85%）存活超过1年，脓肿无复发，并继续接受抗癌治疗。
化脓性肝脓肿可能是肝胰胆恶性疾病终末期的一种表现，预后严重。非肝胰胆恶性疾病患者发生的化脓性肝脓肿有更好的预后机会。
