CAJ | 학술논문

目的总结分析糖尿病并发肝脓肿(septic liver abscess in diabetics,DLA)的临床特点,并探讨其治疗策略.方法对DLA及同期收治的非糖尿病肝脓肿(nondiabetic liver abscess,NDLA)进行回顾性对比分析.结果 DLA主要发生于老年人,男女患病率相近,而NDLA主要发生于40岁左右中年人,男多于女(P＜0.05);DLA的诱因依次为肺部感染、结石性胆囊炎、尿路感染,而NDLA依次为胆道系统病变、腹腔手术等;病原学方面,DLA主要为肺炎克雷伯杆菌等G-杆菌感染,而NDLA则多为金黄色葡萄球菌、大肠杆菌、肺炎克雷伯杆菌等感染;DLA治愈率较对照组低(36.4% vs 67.4%,P＜0.05),平均住院时间较对照组长(29.6±14.1天vs 19.1±12.0天,P＜0.05).结论糖尿病是肝脓肿重要的易患因素之一;早期静脉应用足量抗G-杆菌抗生素控制感染,胰岛素控制血糖以及彻底的手术切开引流,是成功治疗DLA
목적총결분석당뇨병병발간농종(septic liver abscess in diabetics,DLA)적림상특점,병탐토기치료책략.방법대DLA급동기수치적비당뇨병간농종(nondiabetic liver abscess,NDLA)진행회고성대비분석.결과 DLA주요발생우노년인,남녀환병솔상근,이NDLA주요발생우40세좌우중년인,남다우녀(P＜0.05);DLA적유인의차위폐부감염、결석성담낭염、뇨로감염,이NDLA의차위담도계통병변、복강수술등;병원학방면,DLA주요위폐염극뢰백간균등G-간균감염,이NDLA칙다위금황색포도구균、대장간균、폐염극뢰백간균등감염;DLA치유솔교대조조저(36.4% vs 67.4%,P＜0.05),평균주원시간교대조조장(29.6±14.1천vs 19.1±12.0천,P＜0.05).결론당뇨병시간농종중요적역환인소지일;조기정맥응용족량항G-간균항생소공제감염,이도소공제혈당이급철저적수술절개인류,시성공치료DLA
Objective To study the clinical characteristics of septic liver abscess in diabetics (DLA) and search for a therapeutic strategy in the hope of improving life quality of the survivors. Methods Medical records of eleven cases with DLA and 46 cases with nondiabetic liver abscess (NDLA) were reviewed critically and retrospectively. Results (1) DLA often occurred in elderly patients,with similar morbidity in both sexes; (2) Predisposing factors of DLA were pulmonary infection, acute cholecystitis, urinary tract infection; while in NDLA, binary tract disorders and intraabdominal operation were contribute factors with 54% patients being cryptogenic; (3)Klebsiella pneumoniae was the major pathogen in DLA and staphylococcus aureus, Escherichia cloi, Klebsiella pneumoniae, etc. were the major pathogens in NDLA; (4)There was no significant difference in clinical manifestations, location of abscess and size of abscess between these two groups; (5)The misdiagnosis rate was higher in DLA than that in NDLA (54.5% vs 25.6%, P<0. 5);(6)The curative ratio was lower in DLA than that in NDLA (36.4% vs 67.4%, P<0. 05 ), the mean hospitalization time was longer in DLA than that in NDLA (29. 6±14. 1 vs 19.1±12. 0 days,P<0. 05). Conclusion (1)Diabetes mellitus was one of the important predisposing factors for pyogenic liver infection; (2) Early and adequate drainage for pyogenic liver abscesses with parenteral antibiotics and insulin are crucial for the improvement of the outcome of the disease.