暴发性肝脓肿12例诊治体会
发布时间：2018-10-12 10:40
【摘要】：目的探讨暴发性肝脓肿的发病特点、临床表现及预后和转归,为其诊断和治疗提供有益的借鉴。方法回顾性分析哈尔滨医科大学附属第一医院2007年1月至2014年12月连续住院的500例肝脓肿病人中12例暴发性肝脓肿病人的临床资料。结果暴发性肝脓肿发病率为2.4%,首诊误诊率为67%,病死率为25%。发热寒战、腹痛和黄疸为其主要的临床表现,同时伴有多器官功能障碍,以累及呼吸系统最为常见。50%暴发性肝脓肿病人合并糖尿病,91.7%的病原菌为肺炎克雷伯杆菌。在暴发性肝脓肿第一阶段由于脓肿液化不充分,主要以支持治疗为主。第二阶段脓肿逐渐液化后应尽早在超声引导下穿刺或置管引流脓汁。结论暴发性肝脓肿具有发病急、进展快,误诊率、并发症发生率和病死率高的特点,肺炎克雷伯杆菌为其主要病原菌。治疗原则应在抗炎治疗的同时积极纠正多器官功能障碍,尽早引流脓肿。
[Abstract]:Objective to explore the characteristics, clinical manifestations, prognosis and outcome of fulminant liver abscess, and to provide useful reference for diagnosis and treatment. Methods the clinical data of 12 cases of fulminant liver abscess in 500 consecutive patients with liver abscess from January 2007 to December 2014 in the first affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results the incidence of fulminant liver abscess was 2.4%. Fever, chills, abdominal pain and jaundice were the main clinical manifestations, accompanied by multiple organ dysfunction, involving respiratory system was the most common. 50% of fulminant liver abscess patients with diabetes, 91.7% of the pathogens were Klebsiella pneumoniae. In the first stage of fulminant liver abscess due to insufficient liquefaction of abscess, the main treatment is supportive therapy. The second stage abscess should be punctured or catheterized as soon as possible after liquefaction. Conclusion fulminant liver abscess is characterized by rapid onset, rapid progression, high misdiagnosis rate, high incidence of complications and mortality. Klebsiella pneumoniae is the main pathogen of the abscess. The principle of treatment should be active correction of multi-organ dysfunction and drainage of abscess as early as possible while anti-inflammatory therapy.
【作者单位】： 哈尔滨医科大学附属第一医院肝脏外科肝脾外科省部共建教育部重点实验室;
【基金】：高等学校博士学科点专项科研基金资助课题(No.20132307120036) 中国博士后科学基金面上资助(No.2014M551273)
【分类号】：R575.4
[Abstract]:Objective to explore the characteristics, clinical manifestations, prognosis and outcome of fulminant liver abscess, and to provide useful reference for diagnosis and treatment. Methods the clinical data of 12 cases of fulminant liver abscess in 500 consecutive patients with liver abscess from January 2007 to December 2014 in the first affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results the incidence of fulminant liver abscess was 2.4%. Fever, chills, abdominal pain and jaundice were the main clinical manifestations, accompanied by multiple organ dysfunction, involving respiratory system was the most common. 50% of fulminant liver abscess patients with diabetes, 91.7% of the pathogens were Klebsiella pneumoniae. In the first stage of fulminant liver abscess due to insufficient liquefaction of abscess, the main treatment is supportive therapy. The second stage abscess should be punctured or catheterized as soon as possible after liquefaction. Conclusion fulminant liver abscess is characterized by rapid onset, rapid progression, high misdiagnosis rate, high incidence of complications and mortality. Klebsiella pneumoniae is the main pathogen of the abscess. The principle of treatment should be active correction of multi-organ dysfunction and drainage of abscess as early as possible while anti-inflammatory therapy.
【作者单位】： 哈尔滨医科大学附属第一医院肝脏外科肝脾外科省部共建教育部重点实验室;
【基金】：高等学校博士学科点专项科研基金资助课题(No.20132307120036) 中国博士后科学基金面上资助(No.2014M551273)
【分类号】：R575.4
【参考文献】
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1 赵宇;王墨飞;张远石;徐玲R，
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