19例糖尿病合并细菌性肝脓肿临床诊疗研究.doc

19例糖尿病合并细菌性肝脓肿临床诊疗研究[摘要] 目的：总结分析糖尿病合并细菌性肝脓肿（DLA）的临床特点，并探讨其诊疗策略。方法：对19例糖尿病合并细菌性肝脓肿（DLA）患者的临床资料进行回顾性归纳分析。观察指标包括临床表现、并发症、实验室检查、病原学检查、脓肿分布以及治疗方法和疗效。结果：19例DLA均为2型糖尿病患者，多见于血糖控制不良的老年人。临床表现不典型，明显腹痛并不常见（26.3％），细菌培养阳性率低（36.8％）。B超、CT等影像学检查意义重大。单纯抗生素治疗13例，B超下脓肿穿刺5例，外科脓肿切开引流1例。18例康复，治疗总有效率达94.8％。结论：糖尿病合并细菌性肝脓肿临床表现复杂，并发症多，易漏诊、误诊。早期诊断、用胰岛素控制血糖、早期足量应用有效抗生素及适时脓肿引流是成功治疗的关键。 [关键词] 糖尿病；细菌性肝脓肿；DLA；诊断；治疗 [中图分类号] R587 [文献标识码]A [文章编号]1673-7210（2007）12（b）-038-03 The diagnosis and treatment of bacterial liver abscess in diabetics: clinical analysis of 19 cases. WANG Yong-di, SONG Zhen-he, LIU feng, CHE Jin-ling (The Weihai Municipal Hospital of Shandong Province, Weihai264200, China) [Abstract] Objective:To investigate the clinical characteristics and therapeutic strategy of bacterial liver abscess in diabetics(DLA). Methods:19 cases of DLA were retrospectively reviewed. The factors which we analysed were included among the clinical presentation, the other diseases companied with DLA, the general laboratory examination, bacterial culture, the position of abscess in liver, the therapeutic methods and curative effect of treatment.Results:19 cases of DLA were all type 2 diabetes mellitus, and DLA occurred more frequently in elderly patients with hyperglycemia. Clinical features of this disorder were atypical，the occurrence of the right upper abdominal pain was not common. The positive rate of bacteria cultivation in blood, puncture fluids and other sources was lower(36.8%). The B-ultrasonography and computer tomography of liver played an important role in the diagnosis of DLA. 13 cases were treated by antibiotics along, 5 cases submitted to aspiration by the guiding of B-ultrasonography, and 1 case underwent surgical drainage of liver abscess. Among 19 cases, 18 of them were curved successfully.Conclusion:The clinical features of DLA are atypical, and also companied with many complications, which might result in the difficulty of the diagnosis of DLA. Appropriate therapeutic s