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HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH?

机译:化脓性肝病肝切除术:例外的治疗方法?

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Background: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.
机译:背景:化脓性肝脓肿的经皮引流术已被认为是治疗大多数病例的金标准方法。但是,当经皮引流失败或什至在某些特殊情况下,由于多位脓肿,肺叶或节段性手术切除可以解决感染性临床情况。目的:报告由一个手术团队对因化脓性肝脓肿而接受肝切除术的一系列患者。方法:11例患者的年龄在45-73岁(平均和中位数66岁)之间。一共有八男三女。病因是:特发性(n = 4),胆道(n = 2),射频(n = 2),直接延伸(n = 1),门脉(n = 1)和动脉(n = 1)。平均病变直径为9.27厘米(6-20厘米)。结果:平均手术时间为180分钟(120-300)。术中平均失血量为448 ml(50-1500)。手术方法为:右肝切除术(n = 4),左肝切除术(n = 3),左外侧切开术(n = 1),右后切开术(n = 2),S8切除(n = 1)和S1( n = 1)。术后发病率为30%,死亡率为零。住院中位时间为18天(5-45)。中位随访期为49个月(13-78)。有单个病变复发。结论:化脓性肝脓肿可作为肝切除的例外方法。在特殊情况下,这是一个很好的治疗选择。

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