Analysis Of Clinical Characteristics Of180Patients With Pyogenic Liver Abscess

Objective: To summarize the clinical features，diagnosis and treatment experienceof pyogenic liver abscess.Methods: Using statistical description Methods，the clinical data of the diagnosisand treatment to the180cases with pyogenic liver abscess from The First AffiliatedHospital of Dalian Medical University between January2007to December2011wereretrospectively analyzed.Results:1.General Data:The180cases of pyogenic liver abscess treated in our hospital in January2007to2011December were hospitalized confirmed cases.105male，75female，The ratio ofmale to female was1.4:1；the youngest was11years old，the maximum age was90years old，the mean age was58.04±14.78years，the age of peak incidence was between50and59years.2.Underlying diseases:The patients of combined diabetes mellitus，fasting glucose and impaired，impaired glucose tolerance accounted for103cases (57.2%)；the patients of combinedbiliary system diseases (including gallbladder stones， common bile duct stones，chronic cholecystitis，pancreatitis，malignancy and hepatobiliary abdomen after surgery)accounted for28cases (15.6%)；the patients of without basic diseases accounted for33cases (18.3%).3.clinical manifestations:Elevated body temperature of173(96.1%) cases，including high fever (>39°C)accounted for139(77.2%) cases；with obvious chills，fever， chills accounted for121(67.2%) cases；right upper quadrant pain57(31.7%) cases；bloating，fatigue，loss of appetite48(26.7%)； nausea，vomiting41(22.8%) cases；jaundice23(12.8%) cases.4.Laboratory tests:The proportion increased of the white blood cell count were142(78.9%)cases；theproportion increased of neutrophils of147(81.7%)cases；hemoglobin of96(53.3%)cases reduce；transaminase of86(47.8%) cases increase；alkaline phosphatase of101(56.1%) cases increase；γ-glutamyl (γ-GT) of98(54.4%) cases increase；bilirubinof31(17.2%) cases increase；albumin of87(48.3%) cases reduce；ESR of76(86.4%)cases increase in the88patients with inspection of the erythrocyte sedimentation rate；C-reactive protein of55(87.3%) cases elevate in63patients with inspection of theC-reactive protein；fibrinogen (Fib) of168(93.3%) cases elevate; platelet of119(66.1%)cases elevate；glucose of99(55%) cases were abnormal，the highest randomblood glucose was27.2mmol/L；creatinine (Cre) of21(11.7%) cases elevate.5.Pathogens:102patients took blood culture and the pus culture in180，28cases of bloodculture were positive，the positive rate was27.5%，including17cases of Klebsiellapneumoniae，6cases of E.coli，2cases of Staphylococcus aureus，1case of classCorynebacterium diphtheriae，1case of Pseudomonas aeruginosa，and1case ofEnterococcus faecalis.58cases of pus culture were positive，the positive rate was56.9%，of which47cases of Klebsiella pneumoniae，5cases of E. coli，2cases ofStaphylococcus aureus，1case of Streptococcus viridans，1case BowmanAcinetobacter，1case of Citrobacter，1case of Moisture single spore fungus.2cases ofblood culture and the pus culture were detected in Klebsiella pneumoniae，each countone case，so the positive rate of Klebsiella pneumoniae was60.8%.6.Imaging studies:173cases took CT scan were positive in180patients，the positive rate was96.1%；161cases took ultrasound B-positive，the positive rate was89.4%；otherwise7cases took MRI examination. The size of abscess was from3.0cm×3.95cm to13.5cm×11.8cm. Right lobe of single abscess accounted for98(54.4%) cases，the right lobe ofmultiple abscesses for19(10.6%) cases，left lobe of the single abscess for24(13.3%)cases，left lobe of multiple abscess for5(2.8%) cases，abscesses involving the liver leftand right lobe for26(14.4%) cases，caudate lobe abscess for4(2.2%) cases，abscesses inthe liver at the top for4(2.2%) cases.7.Complications:The liver abscess rupture led to diffuse peritonitis accounted for6(3.3%) cases in the180patients.8.Treatment options:The simple application of antibiotic treatment of78cases； antibiotics+ultrasound-guided percutaneous abscess aspiration/catheter drainage (n=92)，amongthese1cases after puncture have not well effect then took surgical treatment；antibiotics+incision and drainage of11cases.9.Abscess diameter:The simple antibiotic treatment group，an average of diameter was4.76±1.04cm；antibiotics+ultrasound-guided abscess aspiration/catheter drainage group，an averageof diameter was8.01±1.52cm；antibiotics+abscess incision and drainage group，anaverage of diameter was10.92±1.45cm.10.Hospital days:The simple antibiotic treatment for4-71days，an average of20.78±12.13days；antibiotics+ultrasound-guided abscess aspiration/catheter drainage for6-88days，anaverage of17.97±12.43days；antibiotics+abscess incision and drainage for12-97days，an average of26.36±24.18days.11.Prognosis:Among the180patients，received excellent treatment accounted for97(53.9%)cases，effective72(40%) cases，5(2.8%) cases due to septic shock，multiple organfailure and death，6cases discharged from hospital，The total effective rate was93.9%.Conclusion:1. The age of PLA tended to increase，the peak age of onset of50to59years.2.The patients with diabetes was the high-risk groups for the PLA.3.The clinical manifestations of PLA tend to atypical, the majority of patientsdon’t have significant abdominal symptoms.4.Klebsiella pneumoniae gradually replaced the Escherichia coli become the mainpathogens of PLA.5.The PLT and Fib in the PLA patients have a transient increase.6.Antibiotics+ultrasound-guided puncture and drainage can shorten the course ofPLA.