单发及多发细菌性肝脓肿临床资料的对比分析

摘要：目的:探讨单发及多发肝脓肿的临床特点及诊治方法。方法:回顾性分析近25年间收治的148例细菌性肝脓肿患者的临床资料，按单发及多发性肝脓肿分组，比较两组临床特征、治疗方法及预后。结果:胆源性在多发性肝脓肿组的比例明显高于单发组（P=0.018），平均年龄、就诊时间及住院天数多发性肝脓肿组也明显高于单发组(P=0.023,0.043，0.015)。多发性肝脓肿患者的碱性磷酸酶水平较高（P=0.021）， 血清白（清）蛋白水平较低（P=0.039）。单发肝脓肿最常见部位在肝右叶(P=0.002)，而多发性肝脓肿更易累及左右两叶(P<0.001)。大肠杆菌是两种肝脓肿最常见的致病菌。单纯抗生素治疗多用于多发脓肿的患者（P=0.022），经皮穿刺置管引流则多用于单发性肝脓肿（P=0.021）。多发性肝脓肿患者发生急性呼吸窘迫综合征（ARDS）的比例较高（P=0.03）。肝脓肿相关的病死率在多发性肝脓肿患者中明显为高（P=0.025）。结论:与单发性肝脓肿相比，多发性肝脓肿病例具有年龄较大、症状持续时间较长、常合并胆道疾病、脓肿多侵及肝脏两叶、容易发生ARDS和病死率较高的特点，治疗多采用手术和/或单纯抗生素治疗。

Comparative analysis of clinical records of single and multiple pyogenic liver abscess

Objective To study the clinical characteristics,and the diagnosis and treatment of single and multiple pyogenic liver abscess.Methods In past 25 years,148 pyogenic liver abscess patients treated in our hospital were divided into single and multiple abscess groups.Clinical features,methods of treatment,and outcome were assessed and compared in the 2 groups.Results A biliary origin was most frequently found in multiple abscesses than that in with single abscess(P=0.018).Mean age,duration of symptoms and length of hospital stay were higher in patients with multiple abscesses(P=0.023,0.043,0.015).High levels of alkaline phosphatase and low levels of albumin were more frequently seen in cases of multiple abscesses than in those of single ones(P=0.021 and 0.039).The lesions were most frequently located on the right lobe in single abscess group(P=0.002);and in the multiple abscess group,the two lobes were usually involved(P<0.001).E.coli was the most frequently cultured organism in either the single or multiple abscess groups.Antibiotic therapy alone was most frequently used in multiple abscess group(P=0.022),and percutaneous aspiration or catheter drainage usually used in single group(P=0.021).ARDS was most frequently seen in the multiple abscesses group(P=0.03).The morality rate was higher in multiple abscess group(P=0.025).Conclusions Compared with single abscess group,multiple abscess group had the following features:the patient was older,duration of symptoms was longer,co-existing biliary diseases,invasion of two lobes,prone to develop ARDS and higher morality rate.Operation and/or simple antibiotic therapy are important therapies for multiple abscesses.