• 首都醫(yī)科大學(xué)宣武醫(yī)院普通外科(北京 100053);

目的　 比較B超引導(dǎo)下經(jīng)皮穿刺置管引流(percutaneous catheter drainage,PCD)與經(jīng)皮細針抽吸(percutaneous needle aspiration,PNA)治療細菌性肝膿腫患者的臨床療效。
方法 　回顧我科1989年1月至2009年12月期間收治的206例細菌性肝膿腫的臨床資料，其中經(jīng)皮穿刺治療（包括PCD與PNA）96例，分別為PCD組(n=56)和PNA組(n=40)，比較2組間治療成功率、并發(fā)癥率、死亡率及住院時間。
結(jié)果 　2組患者間性別、年齡、有無糖尿病、白蛋白水平及膿腫的部位、個數(shù)、大小、來源等差異均無統(tǒng)計學(xué)意義(P gt;0.05)。PCD組與PNA組并發(fā)癥率、死亡率及住院時間差異均無統(tǒng)計學(xué)意義〔1.79%比2.50%，P=1.000； 1.79%比2.50%，P=1.000； 　(19.2±13.1) d 比(20.2±12.9) d，P=0.887〕，但PCD組治療成功率明顯高于PNA組（96.43%比75.00%，P=0.002）。對于直徑小于5 cm的單發(fā)肝膿腫，PNA組與PCD組治療成功率相當(dāng)（13/13比16/17，P=1.000）。
結(jié)論 　PCD治療細菌性肝膿腫較PNA更加有效，對于直徑小于5 cm的單發(fā)肝膿腫，PNA是可選的替代措施。

引用本文： 劉強,曹鋒,王亞軍,劉家峰. 細菌性肝膿腫經(jīng)皮穿刺置管引流與細針抽吸療效比較. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 1083-1086. doi: 復(fù)制

1. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan [J]. Emerg Infect Dis, 2008; 14(10): 1592-1600.
2. 　Jepsen P, Vilstrup H, Schnheyder 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.
3. 　Petri A, Hhn 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.
4. 　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.
5. 　蔣力生, 韋靖江. 肝膿腫破潰77例分析 [J].普外基礎(chǔ)與臨床雜志, 1996； 3(4): 221-223.
6. 　〖JP4〗彭其芳, 熊先澤, 程南生. 膽源性肝膿腫的治療(附12例報道) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(10): 847-848.
7. 　梁國慶, 黃韜, 陸立平. B超引導(dǎo)下經(jīng)皮肝穿刺置管引流治療肝膿腫的臨床應(yīng)用 [J]. 中華肝膽外科雜志, 2007; 13(3): 206-207.
8. 　Singh O, Gupta S, Moses S, et al. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses [J]. Indian J Gastroenterol, 2009; 28(3): 88-92.
9. 　Trcoveanu E, Vlad N, Moldovanu R, et al. Pyogenic liver abscesses [J]. Chirurgia (Bucur), 2008; 103(4): 417-427.
10. 　Rahimian J, Wilson T, Oram V, et al. Pyogenic liver abscess: recent trends in etiology and mortality [J]. Clin Infect Dis, 2004; 39(11): 1654-1659.
11. 　Butler TJ, McCarthy CF. Pyogenic liver abscess [J]. Gut, 1969; 10(5): 389-399.
12. 　Spellberg MA. Treatment of nonamebic (pyogenic) liver abscess [J]. Am J Gastroenterol, 1969; 51(5): 410-417.
13. 　Wang W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses [J]. Surg Today, 2004; 34(4): 323-325.
14. 　McFadzean AJ, Chang KP, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics; a report of 14 consecutive cases with recovery [J]. Br J Surg, 1953; 41(166): 141-152.
15. 　Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses-percutaneous or open drainage? [J]. Singapore Med J, 2007; 48(12): 1158-1165.
16. 　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.
17. 　Alvarez Pérez JA, González JJ, Baldonedo RF, et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess [J]. Am J Surg, 2001; 181(2): 177-186.
18. 　Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage [J]. AJR Am J Roentgenol, 1998; 170(4): 1035-1039.
19. 　Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess [J]. AJR Am J Roentgenol, 2007; 189(3): W138-W142.
20. 　劉強, 王亞軍, 劉家峰, 等. 細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.
21. 　Ng FH, Wong WM, Wong BC, et al. Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess [J]. Aliment Pharmacol Ther, 2002; 16(6): 1083-1090.
22. 　趙世峰, 沈洪. 第46 例-糖尿病伴細菌性肝膿腫(Internet 網(wǎng)上病例討論) [J]. 中國危重病急救醫(yī)學(xué), 2002; 14(8): 511-512.
23. 　Chou FF, Sheen-Chen SM, Chen YS, et al. Prognostic factors for pyogenic abscess of the liver [J]. J Am Coll Surg, 1994; 179(6): 727-732.
24. 　Chung YF. Pyogenic liver abscess-predicting failure to improve outcome [J]. Neth J Med, 2008; 66(5): 183-184.
25. 　Chen SC, Tsai SJ, Chen CH, et al. Predictors of mortality in patients with pyogenic liver abscess [J]. Neth J Med, 2008; 66(5): 196-203.
  1. 1. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan [J]. Emerg Infect Dis, 2008; 14(10): 1592-1600.
  2. 2. 　Jepsen P, Vilstrup H, Schnheyder 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.
  3. 3. 　Petri A, Hhn 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.
  4. 4. 　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.
  5. 5. 　蔣力生, 韋靖江. 肝膿腫破潰77例分析 [J].普外基礎(chǔ)與臨床雜志, 1996； 3(4): 221-223.
  6. 6. 　〖JP4〗彭其芳, 熊先澤, 程南生. 膽源性肝膿腫的治療(附12例報道) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(10): 847-848.
  7. 7. 　梁國慶, 黃韜, 陸立平. B超引導(dǎo)下經(jīng)皮肝穿刺置管引流治療肝膿腫的臨床應(yīng)用 [J]. 中華肝膽外科雜志, 2007; 13(3): 206-207.
  8. 8. 　Singh O, Gupta S, Moses S, et al. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses [J]. Indian J Gastroenterol, 2009; 28(3): 88-92.
  9. 9. 　Trcoveanu E, Vlad N, Moldovanu R, et al. Pyogenic liver abscesses [J]. Chirurgia (Bucur), 2008; 103(4): 417-427.
  10. 10. 　Rahimian J, Wilson T, Oram V, et al. Pyogenic liver abscess: recent trends in etiology and mortality [J]. Clin Infect Dis, 2004; 39(11): 1654-1659.
  11. 11. 　Butler TJ, McCarthy CF. Pyogenic liver abscess [J]. Gut, 1969; 10(5): 389-399.
  12. 12. 　Spellberg MA. Treatment of nonamebic (pyogenic) liver abscess [J]. Am J Gastroenterol, 1969; 51(5): 410-417.
  13. 13. 　Wang W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses [J]. Surg Today, 2004; 34(4): 323-325.
  14. 14. 　McFadzean AJ, Chang KP, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics; a report of 14 consecutive cases with recovery [J]. Br J Surg, 1953; 41(166): 141-152.
  15. 15. 　Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses-percutaneous or open drainage? [J]. Singapore Med J, 2007; 48(12): 1158-1165.
  16. 16. 　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.
  17. 17. 　Alvarez Pérez JA, González JJ, Baldonedo RF, et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess [J]. Am J Surg, 2001; 181(2): 177-186.
  18. 18. 　Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage [J]. AJR Am J Roentgenol, 1998; 170(4): 1035-1039.
  19. 19. 　Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess [J]. AJR Am J Roentgenol, 2007; 189(3): W138-W142.
  20. 20. 　劉強, 王亞軍, 劉家峰, 等. 細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.
  21. 21. 　Ng FH, Wong WM, Wong BC, et al. Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess [J]. Aliment Pharmacol Ther, 2002; 16(6): 1083-1090.
  22. 22. 　趙世峰, 沈洪. 第46 例-糖尿病伴細菌性肝膿腫(Internet 網(wǎng)上病例討論) [J]. 中國危重病急救醫(yī)學(xué), 2002; 14(8): 511-512.
  23. 23. 　Chou FF, Sheen-Chen SM, Chen YS, et al. Prognostic factors for pyogenic abscess of the liver [J]. J Am Coll Surg, 1994; 179(6): 727-732.
  24. 24. 　Chung YF. Pyogenic liver abscess-predicting failure to improve outcome [J]. Neth J Med, 2008; 66(5): 183-184.
  25. 25. 　Chen SC, Tsai SJ, Chen CH, et al. Predictors of mortality in patients with pyogenic liver abscess [J]. Neth J Med, 2008; 66(5): 196-203.