老年糖尿病并发细菌性肝脓肿28例诊治探讨

摘要

目的探讨近年来老年糖尿病(DM)合并细菌性肝脓肿的临床表现、诊断和治疗要点。方法回顾性分析28例DM并发肝脓肿病例。结果老年DM并发肝脓肿多见于男性，以右叶及多发常见；临床表现不典型，好发于2型DM患者；胆囊炎、胆石症是主要致病因素(50％)，诊断首选B超(64.3％)。治疗方法为及时切开引流或B超引导下穿刺，同时应用有效抗生素，用胰岛素控制血糖。本病死因主要为感染及多脏器功能衰竭。结论 DM合并肝脓肿临床表现不典型，诊断较困难。对DM伴有发热者应高度重视。控制血糖，及时治疗胆道感染是预防本病发生的重要措施。%Objective To explore the clinical features,diagnosis and treatment of geriatic diabetes mellitus(DM) with bacteriogenic liver abscesses. Methods Retrospectively analyse 28 causes of DM with liver abscesses. Results Among the 28 cases,22 of whom were males,predilection for right liver occupied, most of whom were multiple. Clinical features of this disorder were atypical. Cholecystitis and gallstone were the main causes of this disorder(50%). Abdominal B-ultrasonography was the firstselected method in the diagnosis(64.3%) ,The methods of treatment were surgical drainage of liver adscesses and aspirations by Bultrasonography guiding,with the effective antibiotic and insulin. MOF and infection were the main causes of death. Conclusions Clinical features of DM with liver abscesses are atypical,the diagnosis is difficult. We should pay attention to patients suffered from DM with fever. Important methods for preventing this disorder are to control fast blood glucose,and treat infection of biliary tract promptly.