280例细菌性肝脓肿的临床特征及诊治分析

发布时间：2018-10-07 19:41

【摘要】：目的通过回顾性分析细菌性肝脓肿的易发因素、临床表现、病原学特征、诊治方式及效果,以提高细菌性肝脓肿的临床诊治水平。方法回顾性分析重庆医科大学附属第一医院2011年3月~2016年8月收治的280例细菌性肝脓肿病例的临床资料。结果280例细菌性肝脓肿中,男性患者占162例,女性患者占118例,年龄17~97(58.53±14.57)岁,年龄≥60岁占141例;合并有糖尿病131例,有肝胆基础疾病131例。通过B超筛查发现肝脓肿133例,CT筛查发现肝脓肿144例。病变分布情况:肝右叶脓肿占182例,肝左叶脓肿占62例,双侧肝脓肿36例;单个脓肿195例。病变范围大小:脓腔最大17.8cm×13.6cm,最小1.3cm×1.1cm。280例细菌性肝脓肿临床症状:发热者有215例,腹痛者有77例,肝区压痛、叩痛、肝大者共占209例。细菌学检测:215例行血培养,165例行脓液培养,其培养结果阳性率分别为18.88%和46.67%。细菌学分布:脓液培养获得细菌学证据有77例,主要致病菌为肺炎克雷伯菌,占64.94%、其次为大肠埃希菌,占12.99%。治疗方式:单纯抗生素治疗115例,经皮留置导管引流联合抗生素治疗64例,手术切除肝脓肿联合抗生素治疗92例,三者联合治疗9例;治疗药物包括头孢类、硝基咪唑类、碳青霉烯类、青霉素类、呼吸喹诺酮类。本组280例肝脓肿患者临床转归情况,临床有效治疗率96.11%(272例),无好转7例,死亡1例。结论本组资料表明细菌性肝脓肿好发于高龄、糖尿病、肝胆基础疾病患者,最常见的致病菌是肺炎克雷伯菌。腹部超声和CT检查是发现肝脓肿的主要检查手段,其中超声具有无创、准确率高、低花费特点,应成为筛查和随访肝脓肿的首选检查。针对肝脓肿治疗,在积极抗感染基础上联合经皮置管引流或手术切除不失为最有效的治疗方案。
[Abstract]:Objective to improve the clinical diagnosis and treatment of bacterial liver abscess by retrospective analysis of the risk factors, clinical manifestations, etiological characteristics, diagnosis and treatment methods and results. Methods the clinical data of 280 cases of bacterial liver abscess treated in the first affiliated Hospital of Chongqing Medical University from March 2011 to August 2016 were retrospectively analyzed. Results among 280 cases of bacterial liver abscess, 162 cases were male and 118 cases were female, the age was 1797 (58.53 卤14.57) years, age 鈮，

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