脾脓肿19例临床资料分析

  目的 分析脾脓肿的临床诊治情况，为其诊疗提供参考。方法 回顾1991年1月—2012年3月北京协和医院19例脾脓肿患者的诊疗情况，分析其一般情况、基础疾病、临床表现、影像学特征、病原学依据、治疗方式、转归等临床资料。结果 19例脾脓肿患者从发病到就诊北京协和医院的中位时间为29 d，9例治愈，8例好转，2例死亡。大多数患者具有脾脓肿的危险因素，如肿瘤、糖尿病和免疫抑制状态等。脾脓肿临床表现不特异，19例患者脾脏均存在影像学变化；最多见的3种临床症状为发热（18例）、畏寒（12例）、寒战（11例）；最多见的3种体征是腹部压痛（9例）、左季肋区叩痛（7例）、脾大（4例）；病原菌培养结果显示最多见者为革兰阴性杆菌（9例），革兰阳性球菌（8例），真菌（4例），7例患者存在2种或2种以上病原菌感染。结论 脾脓肿患者临床表现特异性不高。对于具有危险因素者，应进行相关临床检查，避免漏诊。结合超声等影像学检查，尽早诊断并开始经验性抗感染治疗；及时留取脓液等寻找病原学资料；根据患者情况，个体化选择治疗方案。   

A retrospective analysis of 19 splenic abscess patients

Objective To analyze the clinical manifestations, diagnosis, treatment and prognosis of patients with splenic abscess. Method The clinical data, including baseline clinical data, clinical features, past history, pathogen culture result, treatment and the prognosis were retrospectively analyzed in the patients with the discharge diagnosis splenic abscess from January 1991 to March 2012 in Peking Union Medical College Hospital.Results The media time from onset to Peking Union Medical College Hospital of the 19 patients were 29 days. Among them, 9 patients were cured, 8 were improved and 2 died. Risk factors, such as tumor burden, diabetes, and using immunosuppressive agents etc, can be found in most patients with splenic abscess. All the 19 patients had splenic image changes and non-specific clinical features. The most common three clinical symptoms were fever(18 cases), chills (12 cases) and shivering (11 cases). The most common three signs were abdominal tenderness (9 cases), left upper quadrant sensitive to percussion (7 cases) and splenomegaly (4 cases). The most common etiological culture results were gram negative bacilli (9 cases), gram positive coccus(8 cases), and fungi (4 cases).ConclusionsClinical features are non-specific in splenic abscess patients. Related exam such as ultrasound should be performed on patients with splenic abscess risk factors to avoid misdiagnosis. Empiric antibiotic administration should begin right after the diagnosis based on the image. Pathogen culture should be timely conducted after pus collection. Individual therapeutical protocol should be chosen according to patient′s condition.