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目的：总结细菌性肝脓肿(pyogenic liver abscesses，PLA)的临床特点、诊断及治疗经验，提高诊疗水平。方法：回顾性分析哈尔滨医科大学第二临床医学院2013 年1 月-2014 年12 月收治的75 例PLA患者的临床资料。结果：75 例患者的平均年龄57岁，最大78 岁，最小34 岁。其中，男45 例，女30 例，男：女为1.5:1。75 例患者中表现为发热者69 例(92.0 %)、寒战28 例(37.3%)、右上腹痛66 例(88.0%)，伴恶心呕吐者28 例(37.3%)，黄疸15例(20.0%)，肝肿大8 例(10.7%)。有糖尿病病史患者28 例(37.3%)。胆系疾病 (78.7%) 是本组资料主要的易患因素，其中53 例患有胆囊炎(70.7%)。外周血白细胞增高67 例(89.3%)，血红蛋白降低41 例 (54.7%)，白蛋白降低46 例(61.3%)；75 例患者转氨酶升高58 例(77.3%)。肝右叶单发脓肿多见(75 例患者中36 例，占48%)。51 例 B超确诊，24 例行B 超+CT 或CT 检查。48 例行穿刺液细菌培养及25 例血培养，其中肺炎克雷伯氏菌为主要病原菌。平均住院天数为19 天，多数患者经皮下肝脓肿穿刺或置管引流而好转，1 例漏诊为肺炎，2 例患者反复入院，1 例因菌血症死亡。结论：PLA 的临床表现多样，以发热最为常见；多为肝右叶单发，部分患者血红蛋白及血清白蛋白降低。糖尿病为PLA 最常见基础疾病，胆系疾病是主要的易患因素。肺炎克雷伯杆菌是本组PLA 患者的主要致病菌。

英文摘要:

Objective:To summarize the clinical characteristics, diagnosis and treatment experience of pyogenic liver abscesses, improve the level of diagnosis and treatment.Methods:To retrospectively analyze the clinical data of diagnosis and treatment to the 75 cases with pyogenic liver abscess fromThe Second Affiliated Hospital of Harbin Medical University between January 2013 to December 2014.Results:The mean age of 75 cases was 57 years, the youngest was 34 years old, the maximum age was 78 years old. 45 male, 30 female, the ratio of male to female was 1.5: 1. Most of the 75 cases characterized by fever accounted for 69 (92.0%) cases; chills accounted for 28 (37.3%) cases; right upper quadrant pain 66 (88.0%) cases; nausea, vomiting 28 (37.3%); jaundice 15 (20.0%); hepatauxe8 (10.7%). Diabetes (DM) is the most common complication 28 (37.3%). Biliary system diseases (78.7%) were the main susceptible factors, including 53 (70.7%) cases with cholecystitis. The proportion increased of the peripheral blood leukocytes count for 67 (89.3%) cases; lower hemoglobin 41 (54.7%) cases; albumin deficiency 46 (61.3%) cases, most of the patients with elevated aminotransferase 58 (77.3%) cases. Right lobe of single abscess accounted for 36 (48%). 51 cases being diagnosed by ultrasound B, otherwise 24 cases took CT examination. 48 cases took the pus culture and 25 cases took the blood culture in 75, pneumonia klebsiella was the main pathogenic bacteria. Average hospitalization days was for 19 days. 23 cases simply apply antibiotic treatment, 71 cases by antibiotics and ultrasound-guided percutaneous abscess aspiration/catheter drainage. 1 case was misdiagnosed as pneumonia; 2 patients were hospitalized repeatedly; 1 case died because of bacteremia.Conclusion:The clinical manifestations of PLA varied, fever is the most common. Right lobe of single abscess accounts for high incidence. The hemoglobin and serum album of PLA reduced. Diabetes is the most common complication, and biliary system diseases were the main susceptible factors. In our group, is the major pathogenic bacteria of PLA.

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