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目的探讨隐源性细菌性肝脓肿的临床特点,为临床决策提供相关依据。方法回顾性分析2013年1月至2016年6月间浙江大学医学院附属第二医院肝胆胰外科连续收治的86例细菌性肝脓肿病人的临床资料。根据病因分为隐源性组(51例)和非隐源性组(35例)。比较两组临床表现、实验室及病原学检查结果、治疗及预后情况。结果隐源性组年龄、伴发胆管结石和恶性肿瘤比例低于非隐源性组,而男性病人和糖尿病病人比例高于非隐源性组(P<0.05);隐源性组出现血小板降低和总胆红素升高的比例低于非隐源性组(P<0.05);最常见病原菌为肺炎克雷伯菌,但隐源性组肺炎克雷伯菌的检出率明显高于非隐源性组(P<0.05),而大肠埃希菌的检出率低于非隐源性组(P<0.05);两组治疗均以抗生素联合穿刺引流为主,但隐源性组住院时间较短,预后不良事件的发生率较低(P<0.05)。结论隐源性细菌性肝脓肿好发于中老年男性糖尿病病人,主要病原菌为肺炎克雷伯菌,以控血糖、抗感染、积极穿刺引流为治疗原则,预后较好。
Objective To investigate the clinical features of cryptogenic bacterial liver abscess and provide the basis for clinical decision-making. Methods The clinical data of 86 patients with bacterial liver abscess treated consecutively in the Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Medical College of Zhejiang University from January 2013 to June 2016 were retrospectively analyzed. According to the cause, it was divided into the cryptogenic group (51 cases) and the non-cryptogenic group (35 cases). The clinical manifestations, laboratory and etiological examination results, treatment and prognosis were compared between the two groups. Results The proportion of cryptogenic group was lower than that of non-cryptogenic group in age, associated bile duct stones and malignant tumors, while the proportion of male patients and diabetic patients was higher than that of non-cryptogenic group (P <0.05). The incidence of thrombocytopenia And total bilirubin (P <0.05). The most common pathogen was Klebsiella pneumoniae, but the detection rate of Klebsiella pneumoniae in cryptogenic group was significantly higher than that of non-cryptogenic group (P <0.05), while the detection rate of Escherichia coli was lower than that of the non-cryptogenic group (P <0.05). Both groups were mainly treated with antibiotics combined with puncture and drainage, but the cryptogenic group was hospitalized Shorter time, the incidence of adverse events was lower (P <0.05). Conclusion The cryptogenic bacterial liver abscess occurs mainly in middle-aged and elderly male patients with diabetes. The main pathogen is Klebsiella pneumoniae. Its principle of controlling blood sugar, anti-infection and active puncture and drainage is good prognosis.