[1]廖 伟,畅智慧,刘兆玉. 经皮穿刺引流治疗肝脓肿12年临床经验[J].介入放射学杂志,2013,(10):843-857.
 LIAO Wei,CHANG Zhi? hui,LIU Zhao? yu.. Percutaneous catheter drainage for liver abscess: twelve years’ clinical experience[J].journal interventional radiology,2013,(10):843-857.
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 经皮穿刺引流治疗肝脓肿12年临床经验 ()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2013年10期
页码:
843-857
栏目:
临床研究
出版日期:
2013-10-15

文章信息/Info

Title:
 Percutaneous catheter drainage for liver abscess: twelve years’ clinical experience
作者:
 廖 伟 畅智慧 刘兆玉
Author(s):
 LIAO Wei CHANG Zhi?蛳 hui LIU Zhao?蛳 yu.
  Department of Radiology, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, China
关键词:
 【关键词】 化脓性肝脓肿 经皮穿刺引流术 体层摄影术X线计算机
文献标志码:
A
摘要:
 【摘要】 目的 总结分析细菌性肝脓肿的临床及CT特征,评价经皮穿刺引流术的疗效。方法 回顾性分析近12年来住院治疗的肝脓肿患者的临床资料及CT特征。分析的CT特征包括:病灶数量、是否多房、囊实性、腔内是否含气等。分析影响疗效的因素,并探讨影响住院时间及引流时间的因素。采用统计学方法包括单样本T检验、卡方检验和Fisher精确切验。统计学软件采用SPSS16.0。结果 计有578例患者纳入本研究。主要临床症状为发热,和右上腹疼痛。52例(9.0%)患者存在感染性休克,80例(13.8%)患者并发血流感染。实验室检查异常主要为白细胞及中性粒细胞百分比升高,白蛋白降低,肝酶升高,总胆红素升高, C反应蛋白(CRP)升高。416例(71.9%)血细菌培养或脓汁细菌培养阳性。致病菌占首位的为肺炎克雷伯菌(69.7%)。经皮穿刺引流术治疗肝脓肿的技术成功率99.7%,临床成功率97.4%,病死率0.9%。并发症5例(0.9%),平均住院时间(13.1 ± 7.4)d。平均带管引流时间(29.2 ± 9.3)d。住院时间的影响因素为:脓肿含气、合并感染性休克、合并其他部位感染、合并肝胆胰恶性肿瘤;带管引流时间的影响因素为:脓肿多房、实性,合并肝胆胰恶性肿瘤。合并肝胆胰恶性肿瘤是影响治疗成功率的唯一因素。结论 对于化脓性肝脓肿,只要不合并肝胆胰恶性肿瘤,经皮穿刺引流都应该成为治疗的首选。脓肿多房、实性、含气、合并感染甚至感染性休克等因素没有影响介入治疗的临床成功率,只是延长了住院时间或带管引流时间。

参考文献/References:

 [1] Lee NK, Kim S, Lee JW, et al. CT differentiation of pyogenic liver abscesses caused by Klebsiella pneumoniae vs non?蛳 Klebsiella pneumoniae[J]. Br J Radiol, 2011, 84: 518 ?蛳 525.
[2] 郑继爱, 许根兔, 王晓菁. 猪尾巴导管在CT引导经皮穿刺治疗肝脓肿中的应用[J]. 介入放射学杂志, 2005, 14: 422 ?蛳 423.
[3] Zhu X, Wang S, Jacob R, et al. A 10?蛳 year retrospective analysis of clinical profiles, laboratory characteristics and management of pyogenic liver abscesses in a Chinese hospital[J]. Gut Liver, 2011, 5: 221 ?蛳 227.
[4] Liao WI, Tsai SH, Yu CY, et al. Pyogenic liver abscess treated by percutaneous catheter drainage: MDCT measurement for treatment outcome[J]. Eur J Radiol, 2012, 81: 609 ?蛳 615.
[5] Ochsner A, Debakey M, Murray S. Pyogenic abscess of the liver.An analysis of 47 cases with review of the literature[J]. Am J Surg, 1938, 40: 292 ?蛳 319.
[6] 徐家华, 张家兴, 曹传武, 等. CT引导下肝脓肿穿刺置管引流术的探讨[J]. 介入放射学杂志, 2008, 17: 574 ?蛳 577.
[7] Wong WM, Wong BC, Hui CK, et al. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10?蛳 year period[J]. J Gastroenterol Hepatol, 2002, 17: 1001 ?蛳 1007.
[8] Lok KH, Li KF, Li KK, et al. Pyogenic liver abscess:clinical profile, microbiological characteristics, and management in a Hong Kong hospital[J]. J Microbiol Immunol Infect, 2008, 41: 483 ?蛳 490.
[9] Lin YT, Siu LK, Lin JC, et al. Seroepidemiology of klebsiella pneumoniae colonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries[J]. BMC Microbiol, 2012, 12: 13.
[10] Alkofer B, Dufay C, Parienti JJ, et al. Are pyogenic liver abscesses still a surgical concern?A Western experience[J]. HPB Surg, 2012: 316013.
[11] Jha AK, Das G, Maitra S, et al. Management of large amoebic liver abscess—a comparative study of needle aspiration and catheter drainage[J]. J Indian Med Assoc, 2012, 110: 13 ?蛳 15.
[12] Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome?[J]. J Vasc Interv Radiol, 2009, 20: 1059 ?蛳 1065.
[13] Hui JY, Yang MK, Cho DH, et al. Pyogenic liver abscesses caused by Klebsiella pneumoniae: US appearance and aspiration findings[J]. Radiology, 2007, 242: 769 ?蛳 776.
[14] Lee HL, Lee HC, Guo HR, et al. Clinical significance and mechanism of gas formation of pyogenic liver abscess due to Klebsiella pneumoniae[J]. J Clin Microbiol, 2004, 42: 2783 ?蛳 2785.
[15] Chen SC, Lee YT, Tsai SJ, et al. Clinical outcomes and prognostic factors of Cancer patients with pyogenic liver abscess[J]. J Gastrointest Surg, 2011, 15: 2036 ?蛳 2043.
[16] Johnson RD, Mueller PR, Ferrucci JT, et al. Percutaneous drainage of pyogenic liver abscesses[J]. Am J Roentgenol, 1985, 144: 463 ?蛳 467.
[17] Ogawa T, Shimizu S, Morisaki T, et al. The role of percutaneous transhepatic abscess drainage for liver abscess[J]. J Hepatobiliary Pancreat Surg, 1999, 6: 263 ?蛳 266.
[18] Lai KC, Cheng KS, Jeng LB, et al. Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary ?蛳 pancreatic Cancer[J]. Am J Surg, 2013, 205: 52 ?蛳 57.
[19] Lee SS, Chen YS, Tsai HC, et al. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess[J]. Clin Infect Dis, 2008, 47: 642 ?蛳 650.
[20] Alsaif HS, Venkatesh SK, Chan DS, et al. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae[J]. Radiology, 2011, 260: 129 ?蛳 138.

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备注/Memo

备注/Memo:
 (收稿日期:2012-11-28)
更新日期/Last Update: