77例细菌性肝脓肿临床诊治分析.docVIP

77例细菌性肝脓肿的临床诊治分析 　　作者：路亮,张立翱,郑可佳,姚矾　　作者单位：238000 巢湖市第一人民医院消化内科 　　【摘要】目的 总结探讨细菌性肝脓肿(PLA)的病因、临床表现、病原菌及相应的治疗方法。方法 回顾性分析77 例PLA患者的临床资料，比较抗生素组、经皮穿刺引流组、外科治疗组的临床疗效。结果 肝脓肿多见于青年和中年人，肝右叶多见，其症状以发热伴右上腹痛最多见，细菌来源最常见为隐源性(53.25%)，其次为胆源性(27.27 %)和肺源性(7.79%)，最常见的病原菌依次为金黄色葡萄球菌(16.13%)，肺炎克雷伯杆菌(9.68 %)，普通变形杆菌(6.45%)，大肠杆菌(3.23%)，经皮穿刺引流组的疗效与外科治疗组相似，并发症较少。结论 PLA的症状以发热伴右上腹痛最多见，隐源性感染最多见，主要致病菌为金黄色葡萄球菌、肺炎克雷伯杆菌等。超声引导下经皮肝脓肿穿刺安全有效，可作为直径5～10 cm肝脓肿首选的诊治方法。 　　【关键词】 细菌性肝脓肿,诊断,治疗 　　[Abstract] Objective To analyse and summarize the etiology，clinical feature，pathogenic bacteria and treatment methods of pyogenic liver abscess(PLA).Methods The clinical data of 77 cases with PLA were retrospectively studied，and the treatment result among consertive,aspiration and surgical groups were compared.Results PLA were frequently developed in the right lobe，especially in younger and middle-aged men. The common clinical manifestations were fever and abdominal pain in the right upper quadrant.The common cause of PLA were cryptogenic(53.25%)，biliary tract diseases (27.27%)and pneumonia(7.79%). S.aureus(16.13%)，Klebsiella pneumoniae(9.68 %)，Proteus vulgaris(6.45%)and E.coli(3.23%)were the most common pyogenic pathogen.The effective of percutaneous aspiration and operation aspiration was similarly.The complication of percutaneous aspiration is fewer than operation aspiration.Conclusion The most common clinical feature of PLA was fever and abdominal pain in the right upper quadrant. Cryptogenic is the most common. The most common pyogenic pathogen were S.aureus，Klebsiella pneumoniae and so on. Percutaneous aspiration is safe and effect，it would become the first treatment method in PLA that the diameter is 5 to 10 cm. 　　[Key words] Pyogenic liver abscess; Diagnosis;Treatment 　　细菌性肝脓肿(pyogenic liver abscess ，PLA)是临床较少见的严重的感染性疾病，1994年2月至2008年12月巢湖市第一人民医院共收治细菌性肝脓肿患者77例，现对其临床资料进行分析总结，以进一步提高该病的诊治水平。 　　1 资料与方法 　　1.1 一般资料 　　本组77例细菌性肝脓肿均因不同程度的畏寒、发热和右上腹疼痛等在我院住院治疗，并经腹部超声和(或)CT等检查诊断为肝脓肿，其中男性51例，女性26例，