Knowledge of etiology and timely treatment of underlying causes,when possible,play an important role in the successful therapy of patients with pyogenic liver abscess (PLA).Recent publications from Central Europe and ...Knowledge of etiology and timely treatment of underlying causes,when possible,play an important role in the successful therapy of patients with pyogenic liver abscess (PLA).Recent publications from Central Europe and Southeast Asia hint at considerable differences in etiology.In this article,we aim to elaborate these differences and their therapeutic implications.Apart from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA),there are clear differences in the microbiological spectrum,which implies different risk factors and disease courses.Klebsiella pneumoniae (K.pneumoniae) PLA is predominantly seen in Southeast Asia,whereas,in Central Europe,PLA is typically caused by Escherichia coli,Streptococcus or Staphylococcus,and these patients are more likely to be older and to have a biliary abnormality or malignancy.K.pneumoniae patients are more likely to have diabetes mellitus.Control of septic spread is crucial in K.pneumoniae patients,whereas treatment of the underlying diseases is decisive in many Central European PLA patients.展开更多
目的评价超声引导下穿刺冲洗与传统切开引流治疗乳腺脓肿的临床疗效。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Pub Med、Cochrane Library、Web of Science和EMbase数据库,同时辅以其他检索。检索时间...目的评价超声引导下穿刺冲洗与传统切开引流治疗乳腺脓肿的临床疗效。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Pub Med、Cochrane Library、Web of Science和EMbase数据库,同时辅以其他检索。检索时间均从建库至2015年8月下旬,不限语种。收集所有比较超声引导下穿刺冲洗与切开引流治疗乳腺脓肿的随机对照试验(RCTs)。由两名评价员独立按照纳入及排除标准提取数据并交叉核对,采用Cochrane协作网推荐软件Rev Man 5.3版进行统计分析。结果最终纳入8个RCT,共373例患者。Meta分析结果显示:与切开引流组相比,超声引导下穿刺冲洗治疗乳腺脓肿在治愈率〔OR=2.51,95%CI(1.47,4.28),P=0.000 8〕、有效率〔OR=7.45,95%CI(2.29,24.27),P=0.000 9〕、切口愈合时间〔SMD=-1.77,95%CI(-2.09,1.44),P<0.000 01〕、瘢痕长度〔MD=-2.88,95%CI(-3.43,-2.33),P<0.000 01〕和并发症〔OR=0.18,95%CI(0.05,0.62),P=0.007〕方面的差异均有统计学意义。结论与传统切开引流手术相比,超声引导下穿刺冲洗治疗乳腺脓肿有更高的治愈率和有效率、更短的愈合时间、更小的手术瘢痕和更少的术后并发症。展开更多
Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admit...Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.展开更多
AIM: To define optimum management of the pyogenic liver abscess and assess new trends in treatment. METHODS: One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir In- stitute of Med...AIM: To define optimum management of the pyogenic liver abscess and assess new trends in treatment. METHODS: One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir In- stitute of Medical Sciences, Srinagar, Kashmir (India) from July 2001 to August 2006 were studied to evaluate and define the optimum treatment. RESULTS: Mortality in the surgically treated group of patients was 9.4% (12/119), while those treated non-surgically had a fatality rate of 16.66% (7/42). Multiple liver abscesses treated surgically had a surprisingly low mortality of 30%. The biliary tract (64.97%) was the most common cause of liver abscess. Multiple abscesses, mixed organisms and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor in determining survival.CONCLUSION: Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.展开更多
文摘Knowledge of etiology and timely treatment of underlying causes,when possible,play an important role in the successful therapy of patients with pyogenic liver abscess (PLA).Recent publications from Central Europe and Southeast Asia hint at considerable differences in etiology.In this article,we aim to elaborate these differences and their therapeutic implications.Apart from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA),there are clear differences in the microbiological spectrum,which implies different risk factors and disease courses.Klebsiella pneumoniae (K.pneumoniae) PLA is predominantly seen in Southeast Asia,whereas,in Central Europe,PLA is typically caused by Escherichia coli,Streptococcus or Staphylococcus,and these patients are more likely to be older and to have a biliary abnormality or malignancy.K.pneumoniae patients are more likely to have diabetes mellitus.Control of septic spread is crucial in K.pneumoniae patients,whereas treatment of the underlying diseases is decisive in many Central European PLA patients.
文摘Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.
基金Supported by The Department of Surgery and Medical Records Section Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
文摘AIM: To define optimum management of the pyogenic liver abscess and assess new trends in treatment. METHODS: One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir In- stitute of Medical Sciences, Srinagar, Kashmir (India) from July 2001 to August 2006 were studied to evaluate and define the optimum treatment. RESULTS: Mortality in the surgically treated group of patients was 9.4% (12/119), while those treated non-surgically had a fatality rate of 16.66% (7/42). Multiple liver abscesses treated surgically had a surprisingly low mortality of 30%. The biliary tract (64.97%) was the most common cause of liver abscess. Multiple abscesses, mixed organisms and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor in determining survival.CONCLUSION: Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.
