Pyogenic liver abscess: An audit of 10 years' experience
Pyogenic liver abscess: An audit of 10 years' experience
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DOI：
10.3748/wjg.v17.i12.1622
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发表时间：
2011-03-28
影响因子：
4.3
通讯作者：
Smith, Ross C.
中科院分区：
文献类型：
--
作者：
Pang, Tony C. Y.;Fung, Thomas;Smith, Ross C.
目的：描述我们自己的经验与化脓性肝脓肿在过去的10年中，并探讨与失败的初步经皮therapeutic.METHODS：63 PLA患者在1998年和2008年之间的澳大利亚三级转诊中心的记录进行了回顾性研究。排除阿米巴和包虫病。人口统计学，临床，放射学和微生物学特征，以及手术/放射学干预，recorded.RESULTS：63例患者（42名男性，21名女性）年龄65（+/- 14）岁[平均值+/-（SD）]有前驱症状的中位数（四分位数范围; IQR）为7（5-14）天。只有59%的患者在就诊时发热，然而，血清C反应蛋白升高，在所有47人进行了测量。肝功能检查结果为非特异性异常。67%的患者有孤立性脓肿，而32%的患者有> 3个脓肿，中位（IQR）直径为6.3（4-9）cm。致病菌为：米勒链球菌25%，肺炎克雷伯氏菌21%，土方ichla coil 16%。一个假定的隐源性原因是最常见的（34%）。该系列中有4例患者死亡：1例死于败血症，2例死于晚期癌症，1例死于急性心肌梗死。54例患者的初始手术为放射性抽吸+/-引流，2例患者为手术。17%在住院期间接受了手术治疗。血清低白蛋白血症[平均值（95%CI）：32（29-35）g/L与28（25-31）g/L，P = 0.045]的介绍被认为是唯一的因素失败的初步经皮治疗的单变量analysis.CONCLUSION：解放军是一个诊断的挑战，因为这种情况的介绍是非特异性的。静脉注射抗生素和放射性引流首先可以解决大多数PLA;然而，一小部分患者仍然需要手术引流。(C)2011年百世登。All rights reserved.
AIM: To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS: A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre, were reviewed. Amoebic and hydatid abscesses were excluded. Demographic, clinical, radiological, and microbiological characteristics, as well as surgical/radiological interventions, were recorded.RESULTS: Sixty-three patients (42 males, 21 females) aged 65 (+/- 14) years [mean +/- (SD)] had prodromal symptoms for a median (interquartile range; IQR) of 7 (5-14) d. Only 59% of patients were febrile at presentation; however, the serum C-reactive protein was elevated in all 47 in whom it was measured. Liver function tests were non-specifically abnormal. 67% of patients had a solitary abscess, while 32% had > 3 abscesses with a median (IQR) diameter of 6.3 (4-9) cm. Causative organisms were: Streptococcus miller 25%, Klebsiella pneumoniae 21%, and Escherichla coil 16%. A presumptive cryptogenic cause was most common (34%). Four patients died in this series: one from sepsis, two from advanced cancer, and one from acute myocardial infarction. The initial procedure was radiological aspiration +/- drainage in 54 and surgery in two patients. 17% underwent surgical management during their hospitalization. Serum hypoalbuminaemia [mean (95% CI): 32 (29-35) g/L vs 28 (25-31) g/L, P = 0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION: PLA is a diagnostic challenge, because the presentation of this condition is non-specific. Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs; However, a small proportion of patients still require surgical drainage. (C) 2011 Baishideng. All rights reserved.