| 李瑞娟,康 文,周 云,杜 虹,连建奇.25例脾脓肿临床资料分析[J].,2023,(6):1046-1050 |
| 25例脾脓肿临床资料分析 |
| A Retrospective Analysis of 25 Splenic Abscess Patient |
| 投稿时间：2022-08-29 修订日期：2022-09-25 |
| DOI：10.13241/j.cnki.pmb.2023.06.009 |
| 中文关键词: 脾脓肿 回顾性分析 临床特征 |
| 英文关键词: Splenicabscess Retrospective studies Clinical manifestations |
| 基金项目:国家重大科技专项（2017ZX10204401-002-005）；陕西省重点研发计划项目（2020ZDLSF02-07）；空军军医大学临床研究常规项目（2021LC2222） |
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| 中文摘要: |
| 摘要 目的：分析脾脓肿的临床特点、病原学特点，为诊疗工作提供参考。方法：回顾性分析2009年4月-2021年7月空军军医大学第二附属医院收治的 25例脾脓肿病例，收集其一般人口学特征、实验室检查、影像学检查、病原学检查及预后数据。采用描述性统计方法进行分析。结果：25例脾脓肿患者中，男女比例为4∶1，平均年龄（48.8±18.1）岁，22例（88 %）患者合并1种及以上基础疾病。病程数天至数年，发热为首发症状。病原学检查阳性患者 11例，共培养出11种细菌，大肠埃希菌占首位。脾脓肿同时合并有其他新发疾病者23例（92 %）。实验室检查常见白细胞、中性粒细胞比例及 C 反应蛋白、降钙素原升高。25例患者均通过影像学检查明确诊断。24例患者给予有效抗菌药物治疗，其中5例患者给予经皮脾穿刺引流(PCD)治疗， 1例患者行脾切除术，1例患者行脾周脓肿剥脱术。全部患者中，1例确诊后未治疗出院，2例人类免疫缺陷病毒（HIV）感染患者死亡，2例患者治疗效果不佳自动出院，余20例患者好转或治愈。结论：脾脓肿多发于中老年男性，多合并基础疾病，较少见以单一病种出现。病原菌以革兰阴性菌为主，大肠埃希菌最为常见。可通过影像学检查明确诊断。早期合理选择抗生素联合PCD、外科手术治疗。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the clinical features and etiological pattern of splenic abscesses to guide future diagnosis and treatment. Methods: A retrospective analysis was conducted for the patients with splenic abscess who were treated at Tangdu Hospital, the Air Force Medical University from April 2009 to July 2021. The demographic data, laboratory results, radiological findings, etiology, and outcome were collected. Descriptive analysis was conducted. Results: A total of 25 patients were included in this analysis. The male/female ratio was 4 ∶ 1 with a mean age of (48.8±18.1) years. 20 (80 %) patients had one or more underlying diseases, including Type 2 diabetes mellitus, biliary disease, cardiovascular disease, previous abdominal surgery, tumor, liver cirrhosis, and AIDS. The course of the disease varies from a few days to several years. Fever was the first clinical symptom, followed by upper left abdominal pain and digestive symptoms. Etiological pathogen was identified in 11 cases, and a total of 11 kinds of bacteria were cultured. The results showed that escherichia coli took up the top, including 7 kinds of Gram-negative bacteria and 4 kinds of Gram-positive bacteria. 23 patients had splenic abscesses complicated with other diseases. Laboratory tests showed elevation of white blood cell and neutrophils percentage, as well as C-reactive protein and procalcitonin increased. All 25 patients were diagnosed by radiological findings. All 24 patients were treated with effective antibiotics for anti-infective therapy, among which 5 patients were treated with PCD (percutaneous catheter drainage), 1 patient underwent splenectomy, and 1 patient underwent perisplenic abscess debridement. 1 patient was discharged from hospital without treatment after being diagnosed, 2 HIV patients died eventually, 2 patients were discharged voluntarily after repeated treatment with poor results, and the remaining 20 patients improved or were cured. Conclusion: Splenic abscess is more common in elderly men. Underlying disease was identified in most cases. Patients with diabetes mellitus, biliary disease, cardiovascular disease, previous abdominal surgery and tumor are at high risk of splenic abscesses. The prognosis is poor in HIV patients with splenic abscess. Gram-negative bacteria were the main pathogens, and escherichia coli was the most common. The diagnosis could be confirmed by radiological findings. Early treatment is reasonable selection of antibiotics combined with PCD or surgical treatment. |
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