Are pyogenic liver abscesses still a surgical concern? A Western experience.
Are pyogenic liver abscesses still a surgical concern? A Western experience.
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DOI：
10.1155/2012/316013
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Chiche L
中科院分区：
文献类型：
--
作者：
Alkofer B;Dufay C;Parienti JJ;Lepennec V;Dargere S;Chiche L
背景。化脓性肝脓肿是一种罕见的疾病，其治疗已转向更多地使用经皮引流。手术仍在治疗中发挥作用，但其适应症尚不明确。方法。我们对1999-2010年间我校医院收治的化脓性脓肿病例进行了回顾性研究，并评估了与手术治疗和单纯药物治疗相关的潜在因素。结果。本中心共收治103例肝脓肿患者。病死率为9%。主要症状为发热和腹痛。所有患者的C反应蛋白水平均为6 g/dL。69名患者有一种独特的脓肿。17例单纯使用抗生素治疗，57例采用经皮引流加抗生素治疗。27名接受经皮技术治疗的患者需要手术，29名患者最初接受了手术。最终，43名患者接受了脓肿手术。与内科治疗失败相关的因素是气体形成脓肿(P=0.006)和最初出现感染性休克(P=0.008)。结论。内科和经皮治疗是肝脓肿的标准治疗方法。在最初的治疗失败后，手术仍然是必要的，但也应该被认为是对表现为气性脓肿和感染性休克的病例的早期干预，以及当潜在原因需要立即治疗时。
Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.