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为确定细菌性肝脓肿的治疗结果和与死亡有关的高危因素,对95例细菌性肝脓肿资料采用单因素和多元回归分析。结果显示,71例采用经皮肝穿刺引流(PCD),68例治愈;肝部分切除术加胆肠吻合13例均治愈;12例(含穿刺引流失败1例)接受开腹引流,术后死亡4例。黄疸、感染性休克、多发性脓肿、继发于恶性肿瘤和手术引流与预后不佳有关。低白蛋白血症、凝血酶原时间延长、胆红素、天冬氨酸转氨酶、尿素氮和肌酐增高是死亡率增加的独立因素。结论:经皮肝穿刺引流适用于有各种高危因素的病人。对于局限于肝脏某一部位的胆源性肝脓肿,肝部分切除可获得良好效果。开腹引流的费用和死亡率较高,临床应用逐渐减少。
To determine the treatment outcome of bacterial liver abscess and the risk factors associated with death, single factor and multivariate regression analysis were performed on 95 cases of bacterial liver abscess. The results showed that 71 cases were treated by percutaneous transhepatic drainage (PCD) and 68 cases were cured. Partial hepatectomy combined with cholangioenterostomy were cured in 13 cases. Twelve cases (including puncture and drainage failure in 1 case) were subjected to open drainage and postoperative death 4 cases. Jaundice, septic shock, multiple abscesses, secondary to malignancy, and surgical drainage are associated with poor prognosis. Hypoalbuminemia, prothrombin time, bilirubin, aspartate aminotransferase, urea nitrogen and creatinine increased mortality is an independent factor. Conclusion: Percutaneous transhepatic drainage is suitable for patients with various risk factors. For biliary liver abscess confined to a certain part of the liver, partial hepatectomy can achieve good results. The cost and mortality of open drainage is high, clinical application gradually reduced.