A Clinical Study on Pyogenic Liver Abscess

化膿性肝膿瘍－臨床分析

陳滋彥(Tzy-Yen Chen) ； 陳丹霞(Tan-Hsia Chen) ； 何尉旗(Wei-Chi Ho) ； 林俊哲(Chun-Che Lin) ； 林金坤(Chin-Kun Lin) ； 何錄滄(Lu-Chang Ho)

《中山醫學雜誌》 14卷4期 (2003/12) Pp. 495-503

https://doi.org/10.30096/CSMJ.200312.0002

摘要

中山醫學大學附設醫院大慶院區從1998年7月至2003年12月共5年6個月間，經由抽吸或手術確定為化膿性肝膿瘍者共有94例，男女比例為1.4比1，死亡例8例，佔8.5％。臨床表現以發燒90.4％，畏寒84％最為常見，其次為右上腹疼痛54.2％。膿瘍數目以單一性居多，77.6％，且好發於右葉（82.9％）。主要的伴隨原因為糖尿病（36.2％）、膽石症（26.6％）、原因不明者（18.1％）、癌症（9.5％）。菌血症為最常見的併發症（52.9％）。實驗性檢查以白血球增加（90.4％）最為常見。預後不好的因素有：1.年齡40歲以上，2. 癌症病人，3.腹膜炎，4.多發膿瘍，5.兩葉侵犯，6.多種病原菌，7.血液培養陽性。
致病菌以嗜氧性革蘭氏陰性桿菌為主（87.7％），而厭氧菌的培養陽性率為5.5％。治療方法以抽吸或經皮穿肝引流為主，少數則接受開刀治療。

關鍵字

化膿性肝膿瘍 ； 經皮穿肝引流術

並列摘要

Pyogenic liver abscess is an uncommon complication of intra-abdominal or biliary tract infection and is usually a polymicrobial infection associated with high mortality and high rates of relapse in western countries. However, over the past five and a half years, in the newly founded Taching Hospital, we have treated ninety-four patients (male-to-female ratio 1.4:1) with pyogenic liver abscesses. The abscesses were confirmed in all 94 patients by needle aspiration or operation. Eight patients (8.5%) died.
Its clinical symptoms are, fever (90.4%), chills (84%), and right quadrant pain (54.2%). The majority of these abscesses are solitary (77.6%) and mostly found in the right lobe (82.9%). The major underlying predisposing causes for these abscesses are diabetes mellitus (D.M.)(36.2%), biliary tract stones (26.6%), cryptogenic abscess (18.1%), and cancer (9.5%). Bacteremia is the most common complication (52.9%). The most common I aboratory findings are leukocytosis (92%) and elevated alkaline phosphatase level (85%).
Gram negative bacilli were the most common bacteria encountered (87.7%). The positive culture rates for anaerobes was 5.5%.The most commonly used therapeutic measure was Pyogenic liver abscess is an uncommon complication of intra-abdominal or biliary tract infection and is usually a polymicrobial infection associated with high mortality and high rates of relapse in western countries. However, over the past five and a half years, in the newly founded Taching Hospital, we have treated ninety-four patients (male-to-female ratio 1.4:1) with pyogenic liver abscesses. The abscesses were confirmed in all 94 patients by needle aspiration or operation. Eight patients (8.5%) died. aspiration or continuous percutaneous transhepatic drainage. Three patients underwent surgical intervention.

並列關鍵字

pyogenic liver abscess ； percutaneous transhepatic drainage ； aspiration