40例细菌性肝脓肿的临床分析及治疗体会

目的对我院细菌性肝脓肿的人群分布、临床症状、细菌学诊断和治疗等方面做一分析。方法收集2006年7月-2009年2月于我科确诊为细菌性肝脓肿患者40例,并对这些病例的人群分布、临床表现、伴发基础疾病、实验室检查、细菌学及影像学特征、治疗等方面进行回顾性分析和总结。结果在40例细菌性肝脓肿患者中,发热、寒战、上腹痛是最常见的临床症状;其中大部分患者都合并有基础疾病,最多见的两个易患因素为胆道疾病（90%,36/40）和糖尿病（92.5%,37/40）。在实验室方面最多见的是低蛋白血症、白细胞计数升高及血沉升高。克雷伯杆菌是最常见的病原菌,其次为大肠杆菌和厌氧菌。结论细菌性肝脓肿好发于老年患者或者存在一种或者几种基础疾病的人群,因而细菌性肝脓肿的治疗应强调综合治疗,虽然抗生素是细菌性肝脓肿治疗的基础,但是积极改善患者的基础状况和经皮肝穿刺抽脓与置管引流同样很重要。

Clinical analysis and therapeutic experience of 40 bacterial liver abscess patients

Objective To analyze the population distribution, clinical symptoms, bacteriological diagnosis and treat-ment of bacterial liver abscess （BLA） in our hospital. Methods All 40 patients with BLA admitted to our hospital, from Jul 2006 to Feb 2009 were included. The population distribution, clinical feature, basic underlying diseases, laboratory, bacteriological and radiological features, management strategies were analyzed, retrospectively. Results Fever, chills and right upper quadrant pain were the most common presenting features in the 40 patients. The majority of these patients had underlaying diseases. Thirty-six cases had disease of biliary tract （90% , 36/40） , 37 cases had diabetes mellitus 92.5% , 37/40. Low albumin level, elevation of leucocyte count and erythrocyte sedimentation were the most common laboratory, features. Klebsiella was the most common pathogenic bacteria. The secondly common pathogenic bacterias were escherichia coli and anaerobion. Conclusion Patients with BLA always have two or more underlaying diseases, therefore, the treatment of BLA should emphasize combination therapy. Although the antibiotics were the most important, improving patients＇ general slate of health and percutaneous needle aspiration and continuous catheter drainage were same important.