215例细菌性肝脓肿的临床特征分析

Clinical Characteristics of 215 Bacterial Liver Abscesses

摘要: 目的：探究细菌性肝脓肿患者的临床特征，提供合理的诊疗依据从而提高临床治疗水平。方法：回顾性分析2020年01月~2022年12月青岛大学附属医院收治的215例患有细菌性肝脓肿病人的数据信息资料。结果：在此项研究内，我们发现肝脓肿，男性多发(150例，69.77%)，发病高峰年龄段在50~69岁(65.12%)。有157例患者合并1种或者多种基础病，合并糖尿病者最多(77例，35.81%)，其次是胆道疾病(50例，23.26%)、高血压(46例，21.40%)和既往肝胆手术病史(32例，14.88%)。肝脓肿最主要的临床表现是发热(191例，88.84%)，其次是上腹疼痛(77例，35.81%)，食欲下降(69例，32.09%)，和肩背部疼痛(8例，3.72%)。患者中以单腔肝右叶脓肿居多(168例，78.14%)。在术前检查中，腹部B超检出率88.60%，腹部CT检出率87.37%，腹部MR检出率83.33%。在实验室检查异常指标中，中性粒细胞百分比升高和白蛋白降低最为显著，分别为159例，73.95%和194例，90.23%，ALT与AST异常者占126例，58.61%。51例患者行血培养，29例阳性(56.86%)，在检出阳性的患者中，肺炎克雷伯菌属占86.21%。108例患者行穿刺脓液细菌学培养以及置管，98例阳性(90.74%)，在检出阳性的患者中，肺炎克雷伯菌属占85.71%。治疗方式以抗菌药物联合经皮穿刺置管引流为主(192例，89.30%)，手术治疗患者13例(6.05%)。182例患者治愈，10例患者好转，总有效率为89.30%。结论：细菌性肝脓肿好发于中老年男性，常合并糖尿病以及胆道疾病，主要的临床表现为高热、右上腹疼痛、食欲下降，临床中因B超检出率高以及便捷以其为首选检查，同时结合上腹部CT可协助细菌性肝脓肿的早期诊断。主要的致病病原菌是肺炎克雷伯杆菌，治疗常常选用抗菌药物联合经皮穿刺置管引流，效果好。

Abstract: Objective: To explore the clinical characteristics of patients with bacterial liver abscess, and to pro-vide reasonable diagnosis and treatment basis to improve the clinical level of bed treatment. Methods: 215 patients admitted to the Affiliated Hospital of Qingdao University from January 2020 to December 2022 were retrospectively analyzed. The data of 215 patients with bacterial liver ab-scess were analyzed. Results: In this study, we found that liver abscess was more common in males (150 cases, 69.77%), and the peak age of liver abscess was (50~69) years (65.12%). There were 157 patients with one or more underlying diseases, most of which were diabetes mellitus (77 cases, 35.81%), followed by biliary diseases (50 cases, 23.26%), hypertension (46 cases, 21.4%) and pre-vious history of hepatobiliary surgery (32 cases, 14.88%). The main clinical manifestations of liver abscess were fever (191 cases, 88.84%), followed by upper abdominal pain (77 cases, 35.81%), de-creased appetite (69 cases, 32.09%), and shoulder and back pain (8 cases, 3.72%). The most com-mon abscess (168 cases, 78.14%) was right lobe of liver abscess. In the preoperative examination, the detection rate of abdominal B-ultrasound was 88.60%, abdominal CT was 87.37% and ab-dominal MR was 83.33%. Among the abnormal indexes of laboratory examination, the percentage of neutrophil increased and albumin decreased were the most significant, which were 159 cases (73.95%) and 194 cases (90.23%), respectively. The abnormal ALT and AST accounted for 126 cas-es (58.61%). Of the 51 patients who underwent blood culture, 29 cases were positive (56.86%). Among the positive patients, Klebsiella pneumoniae accounted for 86.21%. 108 patients underwent puncture pus bacteriological culture and catheterization, 98 patients were positive (90.74%). Among the positive patients, Klebsiella pneumoniae accounted for 85.71%. The main treatment methods were antibiotics combined with percutaneous puncture and drainage (192 cases, 89.30%), and surgery (13 cases, 6.05%). 182 patients were cured, 10 patients improved, the total effective rate was 89.30%. Conclusion: Bacterial liver abscess usually occurs in middle-aged and elderly men, often complicated with diabetes and biliary tract diseases. The main clinical manifestations are high fever, right upper abdomen pain and loss of appetite. In clinical practice, B-ultrasound is the first choice due to its high detection rate and convenient, and combined with upper abdominal CT can assist in the early diagnosis of bacterial liver abscess. The main pathogenic bacteria is Klebsiella pneumoniae. The treatment of Klebsiella pneumoniae is often combined with antibacterial drugs and percutaneous puncture and drainage, and the effect is good.