Infectious complications of hepatic artery catheterization procedures in patients with cancer

A total of 353 hepatic artery catheterization procedures were carried out in 211 patients with cancer over a 1-year period (January-December 1988). The procedures included 49 embolizations in 32 patients, 123 chemoembolizations in 73 patients, and 181 chemoinfusions in 106 patients. The overall infection rate was 3.4%. Infectious complications occurred in 3.1% of patients undergoing hepatic artery embolization alone, 1.9% of patients undergoing hepatic artery chemoinfusion, and 4.1% of patients undergoing hepatic artery embolization followed by chemoinfusion. Four patients had infectious complications that included four episodes each of cholangitis, liver abscess, and septicemia. One patient developed a subphrenic abscess in addition to a liver abscess. Enteric gram-negative bacilli (aerobic and anaerobic) were isolated from all four patients. None of the patients had received prophylactic antibiotics. All patients responded to antimicrobial therapy and percutaneous drainage of abscesses.     

Complications of pancreaticoduodenectomy after neoadjuvant chemoradiation in patients with and without preoperative biliary drainage

BACKGROUND: It has been suggested that preoperative biliary drainage increases the risk of infectious complications of pancreaticoduodenectomy. AIMS: The aim of this study was to assess complications related to biliary stents/drains and postoperative morbidity in patients undergoing neoadjuvant chemoradiotherapy for periampullary cancer. PATIENTS: One hundred and eighty-four patients with periampullary neoplasms were prospectively selected for neoadjuvant external beam radiation therapy and 5-fluorouracil-based chemotherapy between 1995 and 2002. METHODS: The data were retrospectively completed and analysed with respect to biliary drainage, efficacy and complications of endoscopic biliary stents and postoperative morbidity. Patients who had undergone a surgical biliary bypass were excluded. RESULTS: Data were completed in 168 patients. One hundred and nineteen patients were treated with endoscopic biliary stents, 18 patients had a percutaneous biliary drain and 31 patients did not require biliary drainage. Hospitalisation for stent-related complications was necessary in 15% of the patients with endoscopic biliary stents. Seventy-two patients underwent pancreaticoduodenectomy. There was no significant difference in the rate of wound infections, intra-abdominal abscesses and overall complications between the groups with and without preoperative biliary drainage. CONCLUSIONS: Postoperative infectious complications are common in patients both with and without preoperative biliary drainage. A statistically significant difference in complication rates was not observed between these groups.     

UNILATERAL VERSUS BILATERAL DRAINAGE USING SELF‐EXPANDABLE METALLIC STENT FOR UNRESECTABLE HILAR BILIARY OBSTRUCTION

Background: There is no consensus on the choice of either unilateral or bilateral drainage in stent placement for patients with unresectable hilar biliary obstruction. The aim of the present study was to clarify which drainage method is superior. Methods: We retrospectively reviewed 82 patients with hilar biliary obstruction who underwent metallic stenting. These patients were divided into a unilateral drainage group (Uni group) and a bilateral drainage group (Bi group). Results: There was no significant difference between the groups in median survival time, median stent patency period, and median complication‐free survival time. The most frequent complication was stent obstruction, followed by cholangitis. Liver abscess was found at a higher frequency in the Bi group (17.6%) than in the Uni group (1.5%) (P = 0.0266). There was no significant difference between the groups in the occurrence of two or more complications (P = 0.247), life‐threatening severe complications (P = 0.0577), and stent obstruction by sludge (P = 0.0912). Conclusion: When compared with bilateral biliary drainage, unilateral biliary drainage is associated with a lower incidence of liver abscess as well as a comparable outcome of stent patency time and complication‐free survival. We therefore propose that hilar biliary obstruction can be treated first by unilateral drainage with a metallic stent and by bilateral drainage only in patients who develop cholangitis in the contralateral biliary tree.     

Percutaneous catheterization of the intestinal loop of hepatico- jejunostomy: a new possibility in the treatment of complex biliary diseases]

OBJECTIVES: After hepatico-jejunostomy, endoscopic exploration of the biliary tract is not possible, and percutaneous transjejunal catheterization seems to be an attractive option. PATIENTS: This is a 10 year prospective evaluation of 55 percutaneous transjejunal biliary interventions in 53 patients. RESULTS: Thirty nine patients had biliary lithiasis, 10 had suspected recurrent biliary cancer, 5 biliary stenosis, and 1 angiocholitic intrahepatic abscess. Initial success was obtained in all patients and 155 procedures were performed. Interventions included strictures, dilatation, stone extraction, stent insertion and tumor biopsy. The complication rate was 15% (mainly benign biliary sepsis) with no deaths and no surgical reoperations. Thirty two of the 39 patients with biliary lithiasis had successful extraction. Eight of the 10 patients with cancer had an endoscopic biopsy and the 2 others underwent drainage. The 5 patients with benign strictures underwent dilatation and stenting. The intrahepatic abscess was treated completely by drainage. CONCLUSIONS: The feasibility of this technique, the low morbidity and the lack of mortality has been demonstrated. This technique is well accepted by patients and may be an alternative to open surgery which is known to be very difficult and risky in patients who have had one or several prior operations.     

Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents

BACKGROUND: Endoscopic management of malignant hilar biliary obstruction is controversial with respect to optimal types of stents and extent of drainage. This study evaluated outcomes of selective MRCP and CT-targeted drainage with self-expanding metallic stents. METHODS: Consecutive patients undergoing attempted palliative ERCP for malignant hilar biliary obstruction were prospectively followed. Whenever possible, management strategy included evaluation and staging for potential resectability before ERCP, with primary placement of metallic stents at the first ERCP in nonsurgical candidates, and early conversion to a metallic stent when a tumor proved to be unresectable. MRCP and/or CT were used to plan selective guidewire access, opacification, and drainage only of the largest intercommunicating segmental ducts. Unilateral stent placement was intended in all cases except for selected patients with Bismuth II cholangiocarcinoma. RESULTS: Thirty-five patients were included. Bismuth classification was I, 10; II, 6; III, 8; and IV, 11. Tumor origin was bile duct (17), gallbladder (5), and metastatic (13). Metallic stents were placed in 27 patients as the initial stent, and in 8 after plastic stent placement. Initial stents were placed endoscopically in 33 patients and percutaneously in 2 patients in whom lumenal tumor precluded ERCP. Stent placement was unilateral in 31 patients and bilateral in 4 patients. There were no episodes of cholangitis or other complications within 30 days after any procedures. Initial metallic stents were clinically effective in 27 (77%) of the 35 patients. Additional percutaneous drainage in 3 patients who did not respond to initial stent placement did not resolve jaundice. Median patency of first metallic stents was 8.9 months for patients with primary bile duct tumors and 5.4 months for all patients, and was not related to Bismuth classification. No further intervention was needed in 25 (71%) patients. CONCLUSIONS: Unilateral metallic stent placement by using MRCP and/or CT to selectively target drainage provides safe and effective palliation in most patients with malignant hilar biliary obstruction.     

Liver abscess complicating transcatheter arterial embolization: a rare but serious complication. A retrospective study after 3878 procedures

OBJECTIVES: Liver abscess is one of the complications of transcatheter arterial embolization (TAE) for hepatocellular carcinoma. We studied the clinical features and analysed the incidence, risk factors, helpful clinical clues, culture profiles and predictive factors of post-TAE liver abscess. The influence of abscess development on the evolution of the tumour process was also studied. METHODS: We retrospectively reviewed records of 3878 TAE procedures performed over a 6 year period. RESULTS: Ten cases of liver abscess developed in nine patients (eight males and one female). The incidence was 0.26% (10 episodes/3878 procedures). The main clinical presentations included fever (91.7%), chills (50%) and abdominal pain (33.3%). All but one febrile patient presented fever in a recurrent form. The positive culture rates were 41.7% for blood and 83.3% for pus. Gram negative bacteria were found in 80% of blood cultures and 68% of pus cultures. Polymicrobial infections were encountered in 60% of the blood cultures and 70% of pus cultures. Management included antibiotics, drainage and operation. Four patients died due to the direct complications of liver abscess. One patient experienced total tumour resolution after successful treatment for liver abscess. Patients with larger liver abscesses and patients with greater age carried higher mortality rates. CONCLUSIONS: Liver abscess is a rare complication after TAE for hepatocellular carcinoma. Recurrent fevers after an initial symptom free interval should arouse suspicion of an abscess. The mortality is high and a large abscess and higher age predict an unfavourable outcome. Abscess formation can lead to complete tumour resolution.     

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures

BACKGROUND AND AIM: Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated. METHODS: After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone. RESULTS: The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage. CONCLUSIONS: Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.     

Management of Complications Associated with Partially Covered Biliary Metal Stents

Background Partially covered metal stents (PCMS) have been increasingly used for both malignant and benign biliary indications. This study reports their complications and subsequent management. Methods Over 5 years, all patients receiving biliary PCMS were followed prospectively until stent-related dysfunction or death. Data were analyzed for the following variables: primary disease, time until revision, and type and reason for revision. Results PCMS were placed in 396 patients (247 with malignant biliary strictures and 149 with benign biliary disease). Complications were observed in 70 patients (18%), occurring a mean time following placement of 159 days. Duodenal migration occurred in 27 cases (6.8%), while proximal migration occurred in 9 cases (2.3%). Cholecystitis was documented in 13 cases (3.3%). There were six cases of stent occlusion due to debris or sludge (1.6%), four cases of pancreatitis (1%), four cases of tumor overgrowth (1%), three cases of benign stenosis in the uncovered portion of the PCMS (0.8%), two cases of abdominal pain (0.5%), one case of an infected biloma (0.3%), and one case of a liver abscess (0.3%). Conclusions Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications.     

EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses

AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. RESULTS: Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collectio...     

Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter

BACKGROUND: It is universally recognized that the most frequent cause of hepatic abscess is biliary disease. The aim of this study was to determine the efficacy of endoscopic drainage and local antibiotic lavage via nasobiliary catheter in the treatment of liver abscesses of biliary origin. METHOD: From January 1994 to December 1995, twenty-two cases of pyogenic liver abscess were treated. Diagnosis was established with ultrasound, computed tomography, endoscopic retrograde cholangiography, and laboratory tests. All patients were assigned prospectively to endoscopic or other non-surgical forms of therapy, depending on the etiology of the pyogenic process. Patients in whom this treatment failed underwent surgical drainage. Twenty patients had hepatic abscesses of biliary origin. In this subgroup, a nasobiliary catheter was placed into the biliary tree for continuous antibiotic lavage (infusion technique: 1 to 1.5 mL/min for 8 to 10 days) after endoscopic sphincterotomy. Two patients had hepatic abscesses of hematogenous and amebic origin, respectively. They were treated only with the appropriate systemic antibiotics. RESULTS: Nineteen patients of the biliary subgroup (95%) and the two patients with non-biliary disease (100%) had complete resolution of the abscesses. "Salvage" surgical drainage was required in only one patient (4.5%). There was no treatment related mortality. CONCLUSION: Endoscopic sphincterotomy and local antibiotic lavage via an endoscopically placed nasobiliary catheter is a safe and effective treatment for biliary liver abscesses. It should be considered as first-line treatment in this subgroup of patients with liver abscesses. Percutaneous or surgical drainage modalities should be reserved for patients in whom endoscopic treatment fails.     

elderly patients with unresectable pancreatic headcancer

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree ( P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A ( P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.     

税制改革背景下会计学专业税法教学存在的问题及对策

税制改革背景下,会计学专业税法教学存在忽视道德素养教育、教学内容重知识轻理论、教学方法单一、实践教学环节弱化等问题。因此,会计学专业税法教学改革应重新定位会计学专业税法教学目标,转变观念,重视税法理论教学,更新教学内容,改进教学方法,加强实践教学环节,让学生真正参与企业实践。     

Bacterial infections associated with hepatic arteriography and transarterial embolization for hepatocellular carcinoma: a prospective study.

Sepsis and liver abscess are serious complications following transarterial embolization (TAE) for hepatocellular carcinoma (HCC). However, the exact incidence and the necessity of antibiotic prophylaxis remain undetermined. Between November 1996 and November 1997, we prospectively studied bacterial infections in 231 HCC patients who underwent 287 angiographic procedures without antibiotic prophylaxis, including 176 TAEs and 111 hepatic arteriographies (HAs). Four of the 111 HAs were complicated by transient asymptomatic bacteremia. Of the 176 TAEs, 2 were associated with asymptomatic bacteremia, and 7 (4%) were associated with symptomatic bacterial infection, including 3 cases of sepsis, 2 of liver abscess, and 2 of infected biloma. For patients with HCC, TAE was associated with a higher risk of developing symptomatic bacterial infections than was HA (4% vs. 0, respectively; P = .03). Previous gastrectomy was the only possible risk factor for liver abscess. Finally, early diagnosis and treatment of these infectious complications usually result in successful outcome.     

Infections associated with transhepatic biliary drainage devices

To determine the infectious complications associated with transhepatic biliary drainage devices, an analysis of the records of 38 patients who underwent placement of a pigtail catheter (n = 11), a Ring catheter/feeding tube (n = 13), or a Carey-Coons endoprosthesis (n = 15) was carried out. Nineteen infectious events occurred in 38 patients with 39 biliary devices. Infections consisted of bacteremia, cholangitis with and without documented bacteribilia, and intrahepatic abscesses and were frequently associated with obstruction (66.7 percent of infectious episodes). The most frequent organisms isolated from blood were Escherichia coli and Pseudomonas aeruginosa, and the most frequent organisms isolated from bile were P. aeruginosa, Klebsiella pneumoniae and Streptococcus faecalis. Trends for more frequent occurrence of neoplasms involving the gallbladder or biliary tract, recent surgical procedures and catheter manipulations in infected as compared with noninfected patients, and a delayed time to infection were noted in patients with an endoprosthesis.     

经内镜微创治疗胆胰疾病的应用价值

目的　探讨经内镜微创治疗胆胰疾病的应用价值。方法　回顾性分析 1995年 7月至 2 0 0 2年 3月经内镜微创治疗胆胰疾病 42 2例次的效果及并发症 ,探讨各种方法的应用价值及优缺点。结果　 42 2例患者分别采取了乳头切开、气囊扩张、机械碎石、取石、鼻胆引流术、胆道放置内支架等治疗 ,其成功率为 94 5 5 %,并发症3 79%。结论　内镜微创治疗胆胰疾病有效、安全且对病人损伤小、可代替部分胆胰疾病的外科手术治疗。     

Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure

AIM: The rate of liver abscesses after radiofrequency ablation (RFA) of liver tumors is probably high in patients with a biliary tract drainage procedure connecting the biliary duct system to the upper gastrointestinal tract. And yet, to date this rate, the time of onset of these abscesses, and the prior status of the bile ducts have never been reported in the literature. METHODS: Among 574 patients treated with RFA over 8 years, only 11 patients (with 13 sessions of RFA, 2 patients undergoing two different RFA sessions) presented with an enterobiliary anastomosis or biliary stenting at the time of RFA. This is a retrospective study of patients who were verified prospectively. RESULTS: Among the 9 patients in whom a biliary tract procedure preceded RFA, 4 developed a liver abscess at the site of RFA, which emerged between 13 and 62 days after RFA. It occurred in spite of different types of short-term antibiotic prophylaxis. Pathogenic bacteria were typical of the digestive flora. Abscesses were cured after percutaneous drainage. No abscess occurred among the 4 patients in whom a biliary tract diversion was performed synchronously with RFA. CONCLUSION: When RFA is performed in a patient with a preexisting biliary diversion, the risk of developing a liver abscess is high. Currently, we are unable to recommend any kind of preventive antibiotherapy. A preexisting biliary diversion is not an absolute contraindication for RFA, but the risk of developing a liver abscess is close to 40-50%. When RFA is performed synchronously with a biliary diversion, the risk of a liver abscess seems to disappear.     

Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin

OBJECTIVES: Pyogenic liver abscesses remain an important and life-threatening clinical problem but their causes and management have changed over the last two decades. The aim of this study was to assess the feasibility and the impact of an endoscopic approach in the management of liver abscesses with suspected biliary origin. METHODS: We reviewed the records of 16 patients suffering from pyogenic liver abscess, who underwent endoscopic retrograde cholangiopancreatography (ERCP) in the setting of biliary diseases between January 1995 and December 2004. Nine patients had an underlying neoplastic disease; 13 had a history of biliary endoscopic maneuvers. When the collections were communicating with the biliary tree, an endoscopic drainage of the abscess was performed either by sphincterotomy, dilation, insertion of a nasobiliary catheter, or stenting. In noncommunicating liver abscesses associated with bile duct abnormalities, biliary decompression was obtained by insertion or replacement of biliary stents. RESULTS: Fourteen patients had liver abscesses communicating with the biliary system and underwent an endoscopic drainage of the cavity. Ten of these patients had an exclusive endoscopic drainage of the abscess, while four cases required additional percutaneous drainage. The two noncommunicating abscesses were associated with previous insertion of biliary stents; these were cured percutaneously after endoscopic stent replacement. Among the 16 patients, 13 had a rapid resolution of symptoms (81%). CONCLUSION: This initial clinical experience suggests that ERCP can demonstrate communications between the biliary tract and liver abscesses, and that an internal drainage of the cavity is feasible and safe.     

Percutaneous drainage of liver and splenic abscess

42 patients with solitary (n = 34) and multiple (n = 8) abscesses of the liver (n = 36) and the spleen (n = 6) were treated with ultrasound guided percutaneous interventions. 38 patients (90%) underwent a total of 97 closed abscess aspirations using needles of 0.9 and 1.3 mm in diameter. In 4 cases (10%) percutaneous catheter drainage was performed. Intravenous antibiotics were used in all cases. Those patients with closed abscess aspiration additionally received local injection of aminoglycosides into the cavity. 40 out of the 42 patients could be treated successfully by percutaneous methods for a cure rate of 95.2%. Percutaneous drainage failure occurred in 2.4%. One patient with multiple liver abscesses and catheter drainage died from myocardial infarction (hospital mortality 2.4%). Complications of ultrasound-guided interventions included two minor bleedings, requiring no therapy, and one pleural empyema (complication rate 7.1%). There were no treatment related lethal complications. These results indicate that abscesses of the liver and the spleen up to 10 cm in diameter can be effectively treated by closed (repetitive) needle aspiration and antibiotic therapy with a relatively low rate of complications. About half of our patients with abscesses of more than 10 cm received percutaneous catheter drainage. On the basis of our experience surgical drainage of liver abscesses and splenectomy in splenic abscesses should be restricted to those cases with percutaneous drainage failure.     

Presentation and endoscopic management of biliary ascariasis

Ascaris lumbricoides is a common parasite and the most serious and dramatic presentation is hepatobiliary and pancreatic ascariasis (HPA). Therefore, this study was planned prospectively to elucidate the clinical presentation of HPA and evaluate the efficacy and safety of endoscopic intervention. In this study we documented 77 consecutive patients with HPA from January 2000 to November 2005. All the patients had endoscopically proven HPA. A total of 77 patients were included in the study. The age ranged from 6 to 80 years, with the third decade most commonly (28.6%) affected. Females were 6 times more likely to be affected than males. The commonest presentation was biliary colic (97.4%); other presentations were acute cholangitis (15.6%), obstructive jaundice (9.1%), acute pancreatitis (6.5%), choledocholithiasis (6.5%), acute cholecystitis (6.5%) and liver abscess (2.6%). In this report 51 (66.2%) had living, 10 (13%) had dead and 16 (20.8%) had both living and dead worms. Choledocholithiasis was associated only with dead worms. From one to 23 worms were found in the biliary tree. In 94.8% of cases we had to remove the worm by wide papillotomy followed by basket extraction. We did not experience any major complications during or following the procedures. Three patients had recurrent HPA during the course of follow-up (1 to 12 months). The majority of patients with HPA presented with biliary colic. This should be kept in mind in the management of an acute abdomen, especially in tropical countries. Endoscopic extraction is a safe and effective procedure for the treatment of HPA.     

Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy

AIM： To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.
METHODS： The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and outcome of surgery.
RESULTS： The patients were predominantly women （10/13） with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain （100%） and fever （77%）. The aetiologies included biliary （n = 6）, cryptogenic （n = 3）, portal （n = 2）, and trauma （n = 2）. Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multiloculation. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy： two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with peritonitis of uncertain pathology. Surgical procedures included deroofment and drainage （n = 9）, liver resection （n = 3）, peritoneal lavage （n = 2）, cholecystectomy （n = 4）, and exploration of common bile duct （n = 2）. One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism.
CONCLUSION： Surgical treatment of pyogenic liver abscess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.