急診無法診斷之肝膿瘍病患特徵分析與預後因子之探討

The characteristics and prognostic factors of the patients with undiagnosed liver abscess at an emergency department

劉冠廷(Kuan-Ting Liu)

指導教授 ： 張永源

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2008年)

https://doi.org/10.6832/KMU.2008.00023

摘要

研究目的: 肝膿瘍為一可能致命的感染症，而其表現常可能無法快速
診斷，有不少病患經急診住院，而在住院之後才診斷出肝膿瘍，而這
些病患和在急診便診斷出肝膿瘍的病患，是否在一開始的表現上就有
所差異，因而造成診斷的困難。並且這些病患的延後診斷，是否會在
預後上有所差異
研究方法: 收集單一醫院在2005-2007 年之間的肝膿瘍住院病患，比
較其在急診便已診斷出肝膿瘍的病患和住院之後才診斷出的病患的
差異。收集病患的基本資料、住院檢驗結果、治療方法和藥物以及預
後結果加以分析。
研究結果：在急診診斷出肝膿瘍的病患，其出現腹痛的比例較高
(73.4% vs. 42.9%, p<0.0005)，症狀出現時間較長(5.52 天 vs. 3.8天, p=0.034)，而在急診未診斷病患出現呼吸道症狀比例較高(24.5% vs. 12.5%, p=0.05)，而胸部X 光疑似肺炎比例也高(14.7% vs. 4.7%, p=0.048)。而在急診診斷與未診斷兩組病患在預後方面，包括死亡(6.3% vs. 8.2%, p=0.740)、休克(19.5% vs. 20.4%, p=0.896)及住院日數(19.6 天 vs. 22.4 天, p=0.173)，都無顯著的差異。
結論與建議：肝膿瘍病患如果沒有腹痛症狀，容易被急診忽略，而如
果有其他部位感染的症狀，如呼吸道症狀，也可能掩蓋肝膿瘍的診
斷，有相當比率的肝膿瘍在急診無法診斷，然而急診安排不明感染的
病患入院，進一步檢查出肝膿瘍治療並不影響到死亡和住院日數。發
燒感染，肝膿瘍是鑑別診斷之一，病患可能有肝功能異常，然而不論
有無肝功能異常，能在急診進行超音波及電腦斷層可能可以增加診斷
率，但實際的經濟效益值得評估。

關鍵字

肝膿瘍 ； 急診 ； 預後因子

並列摘要

Objective: Liver abscess is a life-threatening disease but its presentation is often non-specific. Thus, delayed diagnosis may occur. Many patients are hospitalized via emergency department and liver abscesses are found at ward. We wish to determine if there are differences betweens patients having liver abscesses diagnosed at ED and in the ward, and if the mis or un-diagnosed liver abscesses affect the prognosis.
Materials and Methods: We retrospectively reviewed the
patients discharged from our hospital during 2005-2007 with the diagnosis of liver abscess. The data including patients＇basic information, examination results, methods of treatment and prognosis were collected. The differences between patients having liver abscesses diagnosed at ER and at ward were analyzed.
Results: Patients having their liver abscesses diagnosed at ED had a higher ratio of abdominal pain presentation (73.4% vs.42.9%, p<0.0005), longer symptoms lasting before
hospitalization(5.52 vs. 3.8 days, p=0.034). The patients with liver abscesses undiagnosed at ED had a higher ratio of
respiratory symptoms (24.5% vs. 12.5%, p=0.05), and higher
abnormal chest X-ray suspected pneumonia (14.7% vs. 4.7%,
p=0.048). The prognosis including mortality rate (6.3% vs. 8.2%, p=0.740), septic shock(19.5% vs. 20.4%, p=0.896) and the length of hospital stay (19.6 days vs. 22.4 days, p=0.173) had no significant differences between the diagnosed and undiagnosed groups.
Conclusion and Suggestion: Liver abscesses had a higher ratio of un-diagnosed at ED if the patients had no abdominal pain. Besides, some infection symptoms such as respiratory tract symptoms may mask the finding of liver abscesses. Some patients with liver abscess would be undiagnosed at ED. However, further evaluation and treatment for the patients with fever of unknown
focus would not affect the mortality rate and the longth of
hospital stay of the patients with liver abscess. Liver
abscesses would be the difference diagnosis of fever and sepsis no matter the patients had normal or abnormal liver function test. Higher diagnosis rates would be achieved if more abdominal ultrasounds and computed tomography were performed at ED. However, the cost-effect should be evaluated.

並列關鍵字

liver abscess ； emergency department ； prognostic

參考文獻

參考文獻

1. Mohan S, Talwar N, Chaudhary A, et al. Liver abscess: a clinicopathological analysis of 82 cases. Int Surg 2006;91:228-33.

2. Ruiz-Hernandez JJ, Leon-Mazorra M, Conde-Martel A, et al. Pyogenic liver abscesses: mortality-related factors. Eur J Gastroenterol Hepatol 2007;19:853-8.

3. Chung DR, Lee SS, Lee HR, et al. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect 2007;54:578-83.

4. Okano H, Shiraki K, Inoue H, et al. Clinicopathological analysis of liver abscess in Japan. Int J Mol Med 2002;10:627-30.