化膿性肝膿瘍的臨床經驗與預後因子分析

The Clinical Experience and Analysis of Risk Factors of Pyogenic Liver Abscess

徐文秀(Wen-Hsiu Hsu) ； 郭武憲(Wuo-Shien Guo) ； 賴啟賢(Chii-Shyan Lay) ； 吳國良(Kuo-Liang Wu)

《Journal of Medical Sciences》 16卷6期 (1996/06) Pp. 418-423

摘要

為瞭解化膿性肝膿瘍的臨床特徵與危險因子，以提高患者的存活率，我們分析本院從1988年1月至1993年8月之病例22例，男性12例、女性10例，平均年齡52.5歲（20-82）。來院時之臨床表徵以發燒（81.8%）與右上腹痛（77.3%）最多見。實驗室檢查以白血球升高、血清白蛋白下降及肝轉胺酶上升較多見，分別佔90.9% 、86.4%、77.3%。潛在或伴隨的疾病以糖尿病與膽道疾病最多，兩者皆佔8例（36.4%）。膿瘍的分佈大多在肝右葉（72.7%），且以單一膿瘍為主（72.7%）。膿瘍抽取液的細菌培養，陽性培養率為77.8%，非單一菌種培養佔42.9%，其中以革蘭氏陰性桿菌最多見，尤以肺炎克雷氏菌（Klebsiella pneumonia）最常見。治療：僅用抗生素者4 例，1例死亡，經皮導管引流者15例，3例死亡，接受開刀引流者3例，1例死亡，總死亡率為22.7%。分析預後因子發現：患者若有白血球高於22000/mm^3、總膽色素高於1.8 mg/dl、年齡大於60歲、或伴隨膽道方面的疾病，則有較高的死亡率。

關鍵字

化膿性肝膿瘍 ； 經皮導管引流 ； 肺炎克雷氏菌

並列摘要

Pyogenic liver abscess carries a substantial mortality and difficult therapeutic problems. Objective: To evaluate the risk factors of pyogenic liver abscess. Methods: 22 cases with ultrasound, CT scan and pus cultures proved pyogenic liver abscess, M:F=12: 10, Mean age 52.2 (range 20-82) years old were enrolled. The factors studied were clinical features, laboratory data, lobar distribution, bacteriology, underlying and/or accompanied diseases, and types of treatment. These variables were analyzed with respect to the hospital mortality rate. Results: The most common clinical features and laboratory finding were fever (8 1.8%), RUQ pain (77.3%), Leukocytosis (90.9%:19633 ± 7940/cumm), hypoalbuminemia (86.4%:2.27 ± 0.63 mg/dl) and elevated transaminase (77.3%:97 ± 72 IU/L). Most of the abscesses were solitary (72.7%) and predominant at right lobe of liver (72.7%). Klebsiella pneumonia was the most frequently (57.1%) isolated organism from the abscess cultures and multiple organism grew in 42.9% of cultures. The predominant underlying diseases were Diabetes Mellitus (8/22) and choledocholithiasis (8/22). Fifteen of the 22 patients were treated by ultrasound-guided percutaneous catheter drainage complemented by antibiotic therapy resulting in 3 deaths (20%) while 3 patients were treated by surgical drainage and antibiotics with 1 death (33%). The remaining 4 patients received antibiotics only with 1 death (25%). The overall mortality rate is 22.7%. Univariate analysis revealed that marked leukocytosis (WBC ＞ 22000/cumm), hyperbilirubinemia (＞ 1.8 mg/dl). old age (＞ 60 years old) , and accompanied with choledocholithiasis were associated with a higher mortality rate.

並列關鍵字

liver abscess ； percutaneous drainage ； Klebsiella pneumonia