目的 分析肝脓肿患者肝脏损害的临床特点、病原学、诊断和治疗.方法 回顾性分析1995年1月至2011年12月北京大学第一医院住院治疗的181例成人肝脓肿患者的人口学资料和临床资料.结果 患者中位年龄60(19 ～82)岁,其中有基础病患者139例(76.8％).68例(37.6％)患者入院时考虑肝脓肿的诊断.常见症状有发热(92.8％),出现肝区压痛、叩击痛者仅43％,肝脏功能检查中以低白蛋白血症(72.4％)和谷氨酰转肽酶升高(79.8％)为主、仅44.3％患者同时有丙氨酸转氨酶升高.脓肿以右叶(63％)、单发(74％)为主,直径多为5 ～ 10 cm.67例(37％)隐源性感染患者中,55.2％有糖尿病基础.血培养24例阳性,脓液培养79例阳性,肺炎克雷白菌56例(60.2％),大肠埃希菌21例(22.6％).113例(62.4％)患者,经超声/CT引导下经皮穿刺抽液和(或)置管引流治疗.结论 不足半数肝脓肿患者伴有右上腹阳性症状和体征.实验室检查以低白蛋白血症、谷氨酰转肽酶升高为主.脓肿多累及肝脏右叶、且多为单个.菌种以肺炎克雷白菌和大肠埃希菌为主.临床上需对于没有腹部表现的发热患者(尤其是已有糖尿病基础者),在必要时行影像学检查,以免漏诊、误诊肝脓肿.%Objective To analyse the clinical characteristics of hepatic injury of liver abscess.Methods Demographics and clinical data of 181adult cases of liver abscesses admitted to a tertiary hospital over 16 years( 1995-2011) were retrospectively reviewed.Results Median age was 60 (19-82) years.139 patients(76.8％ ) had underlying diseases.The most common chief complaint was fever( 92.8％ ).The most common physical finding was right-upper-quadrant tenderness (43％). Hypoalbuminemia was in 72.4％ cases.79.8％ cases had an elevated γGT.74％ patients had a single liver abscess,63％ being in the right lobe.67 patients were cryptogenic,among those 55.2％ cases wers diabetes mellitus.113 patients ( 62.4％ ) were treated by percutaneous drainage with antibiotic therapy.Conclusion Patients with positive right-upper-quadrant symptoms and signs were less than a half.Deranged LFTs were Hypoalbuminemia and elevated γGT.Liver abscesses were mainly located in the right lobe and single.
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