- 期刊
脾膿瘍 ：十八病例分析及文獻回顧
Splenic Abscess: An Analysis of Eighteen Patients and Review of the Literature
摘要
脾膿瘍是重少見但常因延遲診斷而致命的疾病，我們以回顧病歷的方式，收集林口長庚醫院急診及加護病房中(1989年1月份到1998年12月)前後十年間的18個病例，分析他們的臨床表徵、治療與預後情形，以作為日後臨床處置之以參考。 病人的平均年齡是46歲(由6歲到71歲)，男性有15位，女性為3位。入院後診斷出脾膿的平均日數是7天(由1天到21天)。最常見的臨床表徵是發燒、畏寒以及左上腹痛。實驗室檢驗最常見的表現是白血球數目增多(n-15，83%)，影像學的檢查常可發現左側肋膜積水(n=10，56%)。常見的危險因子是糖尿病，白血病，酒癮及最近有腹部受傷病史。分離的病菌中較常見的為葡萄球菌(4例)，白色鏈球菌(3例)及沙門氏桿菌(2例)。其中死亡有4例，死因為敗血症引發多重器官衰竭，到院後確工診斷平均時間為11日;存活14位中到院後確立診斷平均時間則為5日，延遲診斷治療是他們脾膿瘍死亡之主要因素。在治療上，單一性病灶可考慮先作超音波或電腦斷層指引下膿瘍引流術加上抗生素的使用，多發性病灶則須儘早作脾切除手術加抗生素的治療。除心內膜炎患者外，術後抗生素的使用不宜超過兩週。
並列摘要
Splenic abscess is an uncommon but usually fatal disease. Review the chart recording from January 1989 to December 1998, eighteen patients with splenic abscess admitted to Chang Gang Memorial Hospital were collected. We analyzed their clinical manifestations, predisposing factors, bacteriologic profile, management and outcome. Their age rrnged from 6 to 71 years (mean, 46 years), including of 15 males and 3 females. Fever, chills and left upper abdominal quadrant pain were the major manifestations. Leukocytosis (15/18, 83%) and left pleural effusion (10/18, 56%) were common laboratory findings. Diabetes mellitus, acute leukemia, alcoholism and recent abdominal trauma were common predisposing conditions. Solitary lesion was found in 19 patients (50%) and multiple lesions were noticed in the other 9 (50%), via abdominal echo or computed tomography. Staphylococcus species (n=4), Streptococcus viridans (n=3), Salmonella species (n=2) were frequently isolated . Fourteen patients survived and 4 died of sever sepsis with multiple organs dysfunction. The average time for the diagnosis of the splenic abscess after arrival to the hospital wall 11 days in 4 fetal cases, and 5 days in the other 14 survived patients. Delayed diagnosis had a wrse outcome. In therapy, percutaneous drainage appeared reasonable for the patients with a singular, unilocular abscess and splenectomy remained definite treatment for multiple lesions. It was unnecessary to continue postoperative antibiotics for more than 2 weeks unless the underlying medical condition mandated longer therapy (e.g., endocarditis).