化膿性肝膿瘍之臨床研究

海軍總醫院以追溯性方式研究78年5月至83年7月，經抽吸或手術步驟，確立診斷為化膿性肝膿瘍並排除阿米巴原蟲感染患例計32例。其平均年齡55.9歲（好發年齡的至70歲），潛在病因以膽道結石（31.3%）最常見，其次為糖尿病患（25.0%）及癌症病患（9.4%），而原因不明者佔25.0%。臨床表徵以發燒（84.4%）及右上腹壓痛（81.3%）為主。實驗室數據以鹼性磷酸酶上升最具特異性。大多數膿瘍（65.6%）為單一性，且好發於右肝（68.7%）。抽吸液細菌培養率為83.3%（單一菌種率92.0%），以革蘭氏陰性嗜氧桿菌75.0%最常見，其次為革蘭氏陽性嗜氧球菌25.0%；而克雷白氏肺炎桿菌佔所有分離菌種一半以上（53.6%）。血液培養率30.8%，均為單一菌種，且為個別抽吸液培養之菌種。併發症中以敗血症（25.0%）最常見，而轉移性眼內炎為較特殊者。治療以全身抗生素投予合併經皮穿肝抽吸或導管引流為主，其經導管引流治癒率達89.6%，本系有11例為多發性膿瘍，死亡四例中（死亡率；12.5%）僅一例為多發性膿瘍。預後與極度肝功能障礙，多重細菌感染，潛在及伴隨疾病有關，而與膿瘍數目無直接關連。

關鍵字

化膿性肝膿瘍；經皮穿肝導管引流；轉移性眼內炎

並列摘要

From May 1989 to July 1994, a total of 32 patients with pyogenic liver abscess (PLA) were studied retrospectively at Navy General Hospital. All diagnosis was confirmed by proceedure of aspiration or operation and amebic infection was excluded in this series. The mean age was 55.9 years (peak age between 40 to 70 years). The most frequent underlying disease was biliary calculi (31.3%) followed by diabetes mellitus (25.0%) and malignancy (9.4%). No underlying disease was found in 25.0% of the patients. The most frequent clinical features were fever (84.4%) and RUQ tenderness (81.3%). Elevation of alkaline phosphatase was the most specciality of laboratory data. Most PLA was single (65.6%) and right lobe was the commonest location (68.7%). The bacterial culture rate of the aspirates was 83.3% and monomicrobial infection comprised 92.0%. Aerobic Gram negative rods were the most frequent pathogens (75.0%) followed by aerobic Gram positive cocci (25.0%), Pathogens of Klebsiella pneumoniae accounting for half of all isolates (53.6%). The bacterial culture rate of blood was 25.0%. All were monomicrobial infection and were similar to those of aspirates individually. Septicemia was the most frequent compliation (25.0%) and the metastatic endophthalmitis was the most special complication. Trentment mainly by systemic antibiotics with percutaneous aspiration or catheter drainage. The cure rate was 89.5% by way of catheter drainge. There were 11 cases with multiple abscesses in this series. Four patients were expired (motality rate: 12.5%) and just only one had multiple abscesses. The prognosis depends upon advanced Iiver function impairment, polymicrobial infection, underlying and associated diseases but without direct relationship with the number of abscess.

並列關鍵字

Pyogenic liver abscess ； percutaneous catheter drainge ； PCD ； metastatic endophthalmitis

國際替代計量

化膿性肝膿瘍之臨床研究

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