不典型但严重的肝脓肿

一例不典型的严重感染的肝脓肿病例，病情极度迅速，入院时肝B超未见特殊异常，但是已经出现感染性休克，很快出现血小板进行减少，“全壁”心梗的心电图。肝功能异常...南京医科大学第二附属医院消化医学中心张发明

次日复查B超，肝脓肿发现了。经过保守治疗，痊愈出院。

带领小组完成全院10年肝脓肿病例回顾分析，发表论文.

A 10-Year Retrospective Analysis of Clinical Profi les, Laboratory Characteristics and Management of Pyogenic Liver Abscesses in a Chinese Hospital
Xiaojuan Zhu, Shaohui Wang, Ravi Jacob, Zhining Fan, Faming Zhang, and Guozhong Ji
Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

Correspondence to: Guozhong Ji and Faming Zhang
Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing 210011, China
E-mail: [e-mail] (GZ Ji); [e-mail] (FM Zhang)

Background/Aims: Pyogenic liver abscess (PLA) is a serious, life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical, laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. Methods: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine
their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. Results: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifi able cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients, respectively. Increased fibrinogen was also detected in 11 of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes
mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). Conclusions: Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay.The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression. (Gut Liver 2011;5:221-227)