暴發(fā)性肝膿腫12例診治體會(huì)
發(fā)布時(shí)間：2018-10-12 10:40
【摘要】：目的探討暴發(fā)性肝膿腫的發(fā)病特點(diǎn)、臨床表現(xiàn)及預(yù)后和轉(zhuǎn)歸,為其診斷和治療提供有益的借鑒。方法回顧性分析哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院2007年1月至2014年12月連續(xù)住院的500例肝膿腫病人中12例暴發(fā)性肝膿腫病人的臨床資料。結(jié)果暴發(fā)性肝膿腫發(fā)病率為2.4%,首診誤診率為67%,病死率為25%。發(fā)熱寒戰(zhàn)、腹痛和黃疸為其主要的臨床表現(xiàn),同時(shí)伴有多器官功能障礙,以累及呼吸系統(tǒng)最為常見。50%暴發(fā)性肝膿腫病人合并糖尿病,91.7%的病原菌為肺炎克雷伯桿菌。在暴發(fā)性肝膿腫第一階段由于膿腫液化不充分,主要以支持治療為主。第二階段膿腫逐漸液化后應(yīng)盡早在超聲引導(dǎo)下穿刺或置管引流膿汁。結(jié)論暴發(fā)性肝膿腫具有發(fā)病急、進(jìn)展快,誤診率、并發(fā)癥發(fā)生率和病死率高的特點(diǎn),肺炎克雷伯桿菌為其主要病原菌。治療原則應(yīng)在抗炎治療的同時(shí)積極糾正多器官功能障礙,盡早引流膿腫。
[Abstract]:Objective to explore the characteristics, clinical manifestations, prognosis and outcome of fulminant liver abscess, and to provide useful reference for diagnosis and treatment. Methods the clinical data of 12 cases of fulminant liver abscess in 500 consecutive patients with liver abscess from January 2007 to December 2014 in the first affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results the incidence of fulminant liver abscess was 2.4%. Fever, chills, abdominal pain and jaundice were the main clinical manifestations, accompanied by multiple organ dysfunction, involving respiratory system was the most common. 50% of fulminant liver abscess patients with diabetes, 91.7% of the pathogens were Klebsiella pneumoniae. In the first stage of fulminant liver abscess due to insufficient liquefaction of abscess, the main treatment is supportive therapy. The second stage abscess should be punctured or catheterized as soon as possible after liquefaction. Conclusion fulminant liver abscess is characterized by rapid onset, rapid progression, high misdiagnosis rate, high incidence of complications and mortality. Klebsiella pneumoniae is the main pathogen of the abscess. The principle of treatment should be active correction of multi-organ dysfunction and drainage of abscess as early as possible while anti-inflammatory therapy.
【作者單位】： 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院肝臟外科肝脾外科省部共建教育部重點(diǎn)實(shí)驗(yàn)室;
【基金】：高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金資助課題(No.20132307120036) 中國博士后科學(xué)基金面上資助(No.2014M551273)
【分類號(hào)】：R575.4
[Abstract]:Objective to explore the characteristics, clinical manifestations, prognosis and outcome of fulminant liver abscess, and to provide useful reference for diagnosis and treatment. Methods the clinical data of 12 cases of fulminant liver abscess in 500 consecutive patients with liver abscess from January 2007 to December 2014 in the first affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results the incidence of fulminant liver abscess was 2.4%. Fever, chills, abdominal pain and jaundice were the main clinical manifestations, accompanied by multiple organ dysfunction, involving respiratory system was the most common. 50% of fulminant liver abscess patients with diabetes, 91.7% of the pathogens were Klebsiella pneumoniae. In the first stage of fulminant liver abscess due to insufficient liquefaction of abscess, the main treatment is supportive therapy. The second stage abscess should be punctured or catheterized as soon as possible after liquefaction. Conclusion fulminant liver abscess is characterized by rapid onset, rapid progression, high misdiagnosis rate, high incidence of complications and mortality. Klebsiella pneumoniae is the main pathogen of the abscess. The principle of treatment should be active correction of multi-organ dysfunction and drainage of abscess as early as possible while anti-inflammatory therapy.
【作者單位】： 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院肝臟外科肝脾外科省部共建教育部重點(diǎn)實(shí)驗(yàn)室;
【基金】：高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金資助課題(No.20132307120036) 中國博士后科學(xué)基金面上資助(No.2014M551273)
【分類號(hào)】：R575.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 趙宇;王墨飛;張遠(yuǎn)石;徐玲R，
本文編號(hào)：2265808
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