Rupture is one of main complications of liver abscess. Seventy-seven patients with rupture of liver abscess are reviewed. Liver abscess may freely rupture into adjacent structures or organs or serous cavities and cause vatious complications. The causative factors of rupture of liver abscess in this series were late medical consultation in the course of the disease, delayed treatment due to misdiagnosis, and improper treatment. Measures that prevent rupture of liver abscess include raising clinical awareness of early diagnosis and timely effective drainage. The authors consider that transperitoneal surgical drainage is the best approach. Most patients with rupture of liver abscess should be treated by surgical drainage togather with transomental or transumbilital veno-catheterization for antibiotic infusion. Patients with rupture of liver abscess usually present a poor prognosis and a high mortality rate. The mortality in this group was 35.1%(27/77), which is closely related to the complications of the rupture of liver abscess.
目的 探讨胆源性肝脓肿的诊治方法。方法 对我院2000~2004年期间收治并确诊为胆源性肝脓肿的12例患者进行分析，在应用抗生素和全身支持的前提下，再依据其病变发生、发展的不同阶段采用不同手段治疗。结果 4例急性期患者中2例行急诊胆道引流手术后治愈，另2例转为亚急性期（脓肿融合期）； 6例亚急性期患者均经B超导向下行脓肿穿刺抽脓后注入抗生素治疗后治愈； 4例慢性期患者行脓肿切开引流后治愈。结论 本病在应用广谱抗生素（二联抗生素）和全身支持治疗的前提下，再根据病变不同时期采用不同方法治疗，可获得良好效果。
Objective To investigate the iron regulated locus in Klebsiella pneumoniae isolates from blood culture of liver abscess patients in Sichuan Provincial People’s Hospital. Methods From January to December of 2015, a total of 10 isolates of Klebsiella pneumoniae were collected from blood culture of liver abscess patients from Sichuan Provincial People’s Hospital. The genomic DNA was extracted to identify the genes of iroB, iroC, and iroD by PCR, and data was further analyzed by Graphpad Prism 5 software. Results Among the 10 Klebsiella pneumoniae clinical strains, 9 strains were iroB positive strains, 9 strains were iroC positive strains, and 10 strains were iroD positive strains, 9 strains were iroB/C/D triple positive. Conclusion The current study suggests that the frequency of triple positive of iroB/C/D in Klebsiella pneumoniae is high in isolates from liver abscess patients, the triple positive of iroB/C/D may contribute to liver abscess.
Objective To formulate an evidence-based treatment plan for a patient with suspected pyogenic liver abscess. Methods Based on the clinical questions raised by a patient with suspected pyogenic liver abscess, we searched The Cochrane Library (Issue 4, 2007), MEDLINE (1996 to January 2008), ACP Journal Club (1991 to January 2008), and Chinese Journal Full-text Database (1994 to January 2008) for systematic reviews, randomized controlled trials (RCTs) and case-control studies. The quality of the included studies was assessed. Results We did not find any systematic reviews or large-scale RCTs involving a comparison between laparoscopic drainage and surgical drainage in the treatment of pyogenic liver abscess. Four clinical retrospective studies closely related to our questions were found and assessed. These studies concluded that laparoscopic drainage for liver abscesses was a safe alternative for patients requiring surgical drainage. Based on the current evidence, as well as our clinical expertise and the patient’s values, laparoscopic drainage was not used for this patient and surgical drainage was applied. The patient was recovered and discharged. Conclusion Current evidence showed that laparoscopic drainage might be effective and safe for liver abscesses but high-quality large-scale randomized controlled trials are still required.
目的总结糖尿病并细菌性肝脓肿(DPHA)的临床特点和诊治经验。方法回顾性分析我院2002年3月至2010年12月期间出院的DPHA与无DPHA(NDPHA)患者的临床资料。结果细菌性肝脓肿患者共22例，其中DPHA患者11例。DPHA组人口学特征、临床表现、白细胞计数与NDPHA组比较差异均无统计学意义(Pgt;0.05); DPHA组血白蛋白低于NDPHA(P=0.006)，而ALT高于NDPHA(P=0.006)。DPHA组病灶个数多于NDPHA组(P=0.032)，且病灶直径也大于NDPHA组(P=0.006)。脓培养: 2组大肠杆菌均为3例; DPHA组克雷伯杆菌4例，而NDPHA组无克雷伯杆菌。DPHA组发生切口感染7例、腹腔感染2例，NDPHA组发生切口感染3例。 DPHA组抗生素使用时间、住院时间及住院费用均高于NDPHA组(Plt;0.05)。2组均分别治愈6例、好转5例，2组均无死亡患者。结论DPHA有其特殊的临床特征，并发症多，住院费用高，但预后与NDPHA差别不大。
ObjectiveTo investigate the clinical characteristics and treatment to improve the prognosis of liver abscess after liver transplantation. MethodsEight cases of liver abscess after liver transplantation who were treated in our hospital from Apr. 1999 to Sep. 2013 were retrospectively analyzed, including clinical presentation, predisposing factors, treatment, and prognosis of outcomes. ResultsIn our group, the incidence of liver abscess after liver transplantation was 2.07% (8/387), and main predisposing factors included biliary complications, hepatic artery complications, and so on. The treatments included sensitive antibiotics therapy, reducing or deactivating immunosuppressant, aspiration and drainage of abscess by the ultrasound guiding, balloon valvuloplasty for biliary stenosis, percutaneous transhepatic cholangial drainage (PTCD), indwelling biliary stents, endoscopic nasobiliary drainage (ENBD), and hepatic resection. All of the 8 cases were followed-up for 3-59 months (median of 23 months), during the follow-up period, 4 cases were cured, 1 case improved, and 3 cases died. ConclusionsHepatic arterial and biliary complications are the most common predisposing factors for liver abscess after liver transplantation. Active prevention and treatment of biliary and hepatic arterial complications after liver transplantation are the key to reduce the occurrence of liver abscess and improve the prognosis of it.
ObjectiveTo evaluate the significance of the accessory left hepatic artery during the procedure of laparoscopic radical gastrectomy for gastric cancer. MethodsClinical data and imaging data of 120 patients with gastric cancer who underwent laparoscopic radical gastrectomy between January 2014 and June 2015 were retrospectively collected, to summarize the significance of accessory left hepatic artery in laparoscopic radical gastrectomy for gastric cancer, and to summarize the main points during the operation. ResultsNine patients (7.5%) had the accessory left hepatic artery in the whole group of 120 patients. Ligation was performed at the beginning of the distal left gastric artery or each branch near the stomach. All patients recovered well postoperatively. There was no significant difference in the total bilirubin, glutamic-pyruvic transaminase, and glutamic-oxalacetic transaminase on 3 days before surgery, 1, 3, and 7 days after surgery (P > 0.05). In addition, there was no occurrence of liver abscesses and intrahepatic biloma. ConclusionsThe incidence of accessory left hepatic artery variation is at a high incidence rate in clinical patients. It needs to be paid attention to protect the accessory left hepatic artery during the laparoscopic radical gastrectomy for gastric cancer, in order to avoid the occurrence of liver abscess and intrahepatic biloma.
Objective To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and (19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.
【摘要】目的探讨糖尿病合并肝脓肿的临床特点及外科治疗。方法回顾性分析22例糖尿病合并肝脓肿的临床资料。结果糖尿病合并肝脓肿多见于血糖控制不佳的中老年患者，其临床表现不典型，脓肿液化不完全，易合并多种疾患。用冲洗、烧灼、填塞手术治疗效果良好。结论冲洗、烧灼、填塞方法具有痛苦少、恢复快、一次性治愈的特点，适用于糖尿病合并的单发及多发肝脓肿。
Objective To analyze the treatment and effect of bacterial liver abscess over the past two decades in one single center. Methods The total 198 patients with bacterial liver abscess during the last twenty years were studied retrospectively. They were divided into three groups according time: 1989-1995 group, 1996-2002 group and 2003-2008 group. Gender and age of patient, location, number and size of abscesses, treatment, hospital days, morbidity of complications and mortality among the groups were compared. Results There were 54, 69, 75 cases in 1989-1995, 1996-2002 and 2003-2008 group respectively. No significant differences were found in gender and age of patient, location, number and size of abscess among three groups （Pgt;0.05）. In 1989-1995 group, 35 cases (64.8%) were treated with laparotomy, 8 cases (14.8%) with laparoscope, and 11 cases (20.4%) with percutaneous treatment (needle aspiration or catheter drainage). In 1996-2002 group, 15 cases (21.8%) were treated with laparotomy, 21 cases (30.4%) with laparoscope, 31 cases (44.9%) with percutaneous treatment (needle aspiration or catheter drainage), and 2 cases (2.9%) were treated with antibiotherapy. In 2003-2008 group, 5 cases (6.7%) were treated with laparotomy, 13 cases (17.3%) with laparoscope, 54 cases (72.0%) with percutaneous treatment (needle aspiration or catheter drainage), and 3 cases (4.0%) were treated with antibiotherapy. The constituent ratio of treatment was significantly different among three groups (P＜0.05). The hospital days was (18.5±12.2) d, (16.4±12.8) d and (20.1±14.6) d, the morbidity of complications was 9.3% (5/54), 4.3%(3/69) and 4.0%(3/75), the mortality was 3.7%(2/54), 1.4%(1/69) and 1.3% (1/75) respectively, but there were no significant differences of three indexes among three groups. Conclusion With the development of surgical techniques, effective antibiotic therapy and percutaneous treatment (needle aspiration or catheter drainage) have been the main therapeutic methods, and laparoscopy and laparotomy are necessary supplement.