Pyogenic liver abscess in Taiwan: emphasis on gas-forming liver abscess in diabetics.
Pyogenic liver abscess in Taiwan: emphasis on gas-forming liver abscess in diabetics.
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发表时间：
1993-11
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通讯作者：
C. Yang;Chiung Yu Chen;Xi-Zhang Lin;Ting-Tsung Chang;Jeng‐Shiann Shin;Ching‐Yih Lin
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作者：
C. Yang;Chiung Yu Chen;Xi-Zhang Lin;Ting-Tsung Chang;Jeng‐Shiann Shin;Ching‐Yih Lin
本文研究了4年内97例化脓性肝脓肿：27.8%（27例）与胆道结石有关，5.2%（5例）与胆道癌有关，2例（2.1%）糖尿病与肛门感染有关，但63.9%（63例）被诊断为隐源性。隐源性组40例（64.5%）合并糖尿病，23例（23/40，57.5%）合并产气感染。所有患者均接受静脉抗生素治疗、经皮穿刺抽吸、引流或手术治疗。总死亡率为16.5%。单纯糖尿病，无明显感染灶，是化脓性肝感染的重要易感因素。此外，为了评估气体形成的化脓性肝感染的临床意义，我们将这42例糖尿病患者在超声和CT扫描后分为气体形成组和非气体形成组。肺炎克雷伯菌是两组的主要病原菌。除产气组AST水平较高外，两组在临床表现、并发症、细菌培养或实验室数据方面均无显著差异。然而，产气组的死亡率较高（30.4% vs. 5.3%）。在糖尿病患者中，产气性肝脓肿很常见。化脓性肝脓肿的早期充分引流和肠外抗生素是其治疗的关键。
Ninety-seven cases of pyogenic liver abscesses in a 4-yr period were studied: 27.8% (27 cases) were associated with biliary tract stone, 5.2% (five cases) were associated with biliary tract cancer, and there were two cases of diabetes (2.1%) associated with anal infection, but 63.9% (63 cases) were diagnosed as cryptogenic. Forty patients (64.5%) in the cryptogenic group had diabetes mellitus, and 23 of them (23/40, 57.5%) had gas-forming infection. All patients received parenteral antibiotics therapy, percutaneous aspiration, drainage, or operation. The overall mortality was 16.5%. Diabetes mellitus alone, without demonstrable infectious foci, was an important predisposing factor for pyogenic liver infection. Furthermore, to evaluate the clinical importance of gas-forming pyogenic liver infections, we separated these 42 diabetic patients into gas-forming and non-gas-forming groups, after sonography and CT scan. Klebsiella pneumoniae was the major pathogen in both groups. There was no significant difference in the clinical manifestations, complication, bacterial culture, or laboratory data between these two groups, except that the AST level was higher in the gas-forming group. However, the gas-forming group had higher mortality rate (30.4% vs. 5.3%). Gas-forming liver abscesses were common among the diabetics. Early and adequate drainage for pyogenic liver abscesses with parenteral antibiotics are crucial in their management.