• 蘭州大學(xué)第二醫(yī)院普外一科(甘肅蘭州 730000);

目的  比較開腹、腹腔鏡和經(jīng)皮肝穿刺引流3種方法治療細(xì)菌性肝膿腫的優(yōu)劣性,為細(xì)菌性肝膿腫治療方法的選擇提供參考依據(jù)。
方法  回顧性分析筆者所在醫(yī)院2010年9月至2011年7月期間收治的39例細(xì)菌性肝膿腫患者的臨床資料,根據(jù)其治療方式將患者分為開腹組、腹腔鏡組和經(jīng)皮經(jīng)肝穿刺引流組(穿刺組)3組,對3組的首次治愈者比例、1個月治愈者比例、發(fā)生并發(fā)癥者比例、住院時間及住院費用進(jìn)行比較。
結(jié)果  開腹組、腹腔鏡組和穿刺組首次治愈者比例分別為10/12、8/9及12/18,3組間差異有統(tǒng)計學(xué)意義(P<0.05); 1個月治愈者比例分別為11/12、9/9及17/18,3組間差異無統(tǒng)計學(xué)意義(P>0.05);發(fā)生并發(fā)癥者比例分別為2/12、1/9及2/18,腹腔鏡組和穿刺組之間的差異無統(tǒng)計學(xué)意義(P>0.05),2組與開腹組相比差異均有統(tǒng)計學(xué)意義(P<0.05);住院時間分別為(15.4±4.5) d、(9.7±2.3) d及 (16.7±5.8) d (P<0.05);住院費用分別為(1.9±0.5)萬元、(1.3±0.3)萬元及(0.8±0.2)萬元(P<0.05)。
結(jié)論  開腹組、腹腔鏡組和穿刺組3種治療方法各有利弊,個體化選擇治療方式是肝膿腫的治療策略。

引用本文: 俞澤元,李玉民,羅長江,焦作義. 細(xì)菌性肝膿腫治療方法的選擇(附39例報道). 中國普外基礎(chǔ)與臨床雜志, 2012, 19(10): 1120-1122. doi: 復(fù)制

1. Wong WM, Wong BC, Hui CK, et al. Pyogenic liver abscess:retrospective analysis of 80 cases over a 10-year period[J]. J Gastroenterol Hepatol, 2002, 17(9): 1001-1007.
2. Wang W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses[J]. Surg Today, 2004, 34(4): 323-325.
3. Ferraioli G, Garlaschelli A, Zanaboni D, et al. Percutaneous and surgical treatment of pyogenic liver abscesses:observation over a 21-year period in 148 patients[J]. Dig Liver Dis, 2008, 40(8): 690-696.
4. 劉強(qiáng), 王亞軍, 劉家峰, 等. 細(xì)菌性肝膿腫治療的單中心20年回顧分析[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(5): 389-392.
5. Lazarenko VA, Okhotnikov OI, Chukhraev AM, et al. Minimally invasive surgery of liver abscesses[J]. Vestn Khir Im I I Grek, 2003, 162(2): 88-91.
6. 常自健, 馬志偉, 王雁霞, 等. B超引導(dǎo)下穿刺引流腹腔深部膿腫36例體會[J]. 中國普外基礎(chǔ)與臨床雜志, 2002, 9(4):231-232.
7. 劉強(qiáng), 曹鋒, 王亞軍, 等. 細(xì)菌性肝膿腫經(jīng)皮穿刺置管引流與細(xì)針抽吸療效比較[J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 1083-1086.
8. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease,Taiwan[J]. Emerg Infect Dis, 2008, 14(10): 1592-1600.
9. Jepsen P, Vilstrup H, Schønheyder HC, et al. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977-2002[J]. Aliment Pharmacol Ther, 2005, 21(10): 1185-1188.
10. Petri A,Höhn J, Hódi Z, et al. Pyogenic liver abscess——20 years’ experience. Comparison of results of treatment in two periods[J]. Langenbecks Arch Surg, 2002, 387(1): 27-31.
11. Yu SC, Ho SS, Lau WY, et al. Treatment of pyogenic liver abscess:prospective randomized comparison of catheter drainage and needle aspiration[J]. Hepatology, 2004, 39(4): 932-938.
12. Butler TJ, McCarthy CF. Pyogenic liver abscess[J]. Gut, 1969, 10(5): 389-399.
13. Tan YM, Chung AY, Chow PK, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5cm[J]. Ann Surg, 2005, 241(3): 485- 490.
14. 彭建平, 何生. 糖尿病合并肝膿腫的外科治療(附22例報告)[J]. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(2): 173-174.
15. 王存川. 實用腹腔鏡外科手術(shù)學(xué)[M]. 廣州: 暨南大學(xué)出版社, 2002: 105-106.
  1. 1. Wong WM, Wong BC, Hui CK, et al. Pyogenic liver abscess:retrospective analysis of 80 cases over a 10-year period[J]. J Gastroenterol Hepatol, 2002, 17(9): 1001-1007.
  2. 2. Wang W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses[J]. Surg Today, 2004, 34(4): 323-325.
  3. 3. Ferraioli G, Garlaschelli A, Zanaboni D, et al. Percutaneous and surgical treatment of pyogenic liver abscesses:observation over a 21-year period in 148 patients[J]. Dig Liver Dis, 2008, 40(8): 690-696.
  4. 4. 劉強(qiáng), 王亞軍, 劉家峰, 等. 細(xì)菌性肝膿腫治療的單中心20年回顧分析[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(5): 389-392.
  5. 5. Lazarenko VA, Okhotnikov OI, Chukhraev AM, et al. Minimally invasive surgery of liver abscesses[J]. Vestn Khir Im I I Grek, 2003, 162(2): 88-91.
  6. 6. 常自健, 馬志偉, 王雁霞, 等. B超引導(dǎo)下穿刺引流腹腔深部膿腫36例體會[J]. 中國普外基礎(chǔ)與臨床雜志, 2002, 9(4):231-232.
  7. 7. 劉強(qiáng), 曹鋒, 王亞軍, 等. 細(xì)菌性肝膿腫經(jīng)皮穿刺置管引流與細(xì)針抽吸療效比較[J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 1083-1086.
  8. 8. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease,Taiwan[J]. Emerg Infect Dis, 2008, 14(10): 1592-1600.
  9. 9. Jepsen P, Vilstrup H, Schønheyder HC, et al. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977-2002[J]. Aliment Pharmacol Ther, 2005, 21(10): 1185-1188.
  10. 10. Petri A,Höhn J, Hódi Z, et al. Pyogenic liver abscess——20 years’ experience. Comparison of results of treatment in two periods[J]. Langenbecks Arch Surg, 2002, 387(1): 27-31.
  11. 11. Yu SC, Ho SS, Lau WY, et al. Treatment of pyogenic liver abscess:prospective randomized comparison of catheter drainage and needle aspiration[J]. Hepatology, 2004, 39(4): 932-938.
  12. 12. Butler TJ, McCarthy CF. Pyogenic liver abscess[J]. Gut, 1969, 10(5): 389-399.
  13. 13. Tan YM, Chung AY, Chow PK, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5cm[J]. Ann Surg, 2005, 241(3): 485- 490.
  14. 14. 彭建平, 何生. 糖尿病合并肝膿腫的外科治療(附22例報告)[J]. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(2): 173-174.
  15. 15. 王存川. 實用腹腔鏡外科手術(shù)學(xué)[M]. 廣州: 暨南大學(xué)出版社, 2002: 105-106.