Therapeutic Analysis For 91 Cases Of Bacterial Liver Abscess

Objective: To contrast PDLA (puncture drainage for liver abscess by ultrasound or CT), LDLA (laparoscopic drainage of liver abscess) and IDLA (incision and drainage for liver abscess) in aspects of curative effect, dominant position, social effect, economic effect and so on.Method: A retrospective research to 91 patients of bacteria liver abscess (BLA) in our hospital from 1 January, 2005 to 1 January, 2010, 41 of whom received PDLA, 25 received LDLA, 25 received IDLA. Contrasted preoperative and postoperative information of three groups through statistical method, such as AST (aspartate transaminase), ALT (alanine transaminase), ALP (alkaline phosphatase), CHE (cholinesterase), ALB (albumin) and general information before operation, leukocyte before operation, days returning to normal of leukocyte after operation, hospital days after operation, days returning to normal of body temperature, days of removing drainage tube, total expense in hospital and so on.Result: (1) No statistical difference of general information before operation including age, gender, abscess position and maximum diameter (p>0.05).(2) No statistical difference of value or value change of AST, ALT, ALP, CHE and ALB between preoperation and postoperation (p>0.05).(3) No statistical difference of days of removing drainage tube after operation. However, there were statistical differences in aspects of total expense in hospital, hospital days after operation, days returning to normal of body temperature, and days returning to normal of leukocyte after operation. PDLA was better than other two groups.Discussion: Bacteria liver abscess (BLA) is a remote but new one of liver diseases."Remote"is due to its long history."New"is due to a great many ways to cure it. In the past, mortality of BLA was higher because of unclear study to BLA, worse diagnostic technique, worse antibiotics and worse operative technique. Now, with advancement of medical techenique, antibiotics, auxiliary examination and operative technique, the therapy of BLA become easier. Surgical advancement of BLA brings greater gospel to patients of BLA. But which is the best one in so many ways to cure BLA? So it is necessary to contrast these three ways (PDLA, LDLA and IDLA).Firstly, there was no statistical difference of general information before operation including age, gender, abscess position and maximum diameter. So general condition of these three groups were similar.Secondly, BLA is a systemic consumptive disease which is harmful to liver. So I focused on some biochemical indicators related with hepatic function, such as AST, ALT, ALP, CHE and ALB, which were chosen from the latest value before operation as preoperative indicators and the value of the fifth to seventh day after operation as postoperative indicators of curative effect. Besides, change of biochemical indicators between preoperation and postoperation was also indicated. The result was that these three groups had no statistical difference in all biochemical indicators through careful statistical analysis (p>0.05). So considering similar harmful degrees of liver before operation, three ways were also similar in improving liver function of patients (that was they were similar in this aspects). Thirdly, regular indicators after operation had statistical difference except days of removing drainage tube after operation. In terms of total expense in hospital, PDLA was apparently lower than other two groups. PDLA had higher clinic feasibility and could be carried out easily in different grade hospitals. Also it met the need of patients getting lower paid. Hospital days after operation was also an important indicator reflecting speed of recovery of patients, which of PDLA was less than IDLA, and LDLA was in between. Hospital days of three groups increased little by little. Patients receiving PDLA needed less hospital days with little influence to personal ordinary life, work and study. So it was better than others in terms of social effect. Days returning to normal of leukocyte after operation was another important indicator reflecting inflammation. In this study, days of PDLA was apparently less than others and LDLA was similar to IDLA.As described above, PDLA, LDLA and IDLA are effective to BLA. Direct therapeutic effects of them are almost identical. However, PDLA is more superior to LDLA and IDLA in terms of economic effect, social effect and humanistic concern. What is more, less pain and smaller scar after operation are popular with patients. So PDLA should be chosen as the optimal way to cure BLA when patients have similar condition and appropriate indication.