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摘要: 目的提高对糖尿病合并肺炎克雷伯杆菌肝脓肿的诊治水平。方法回顾性分析16例糖尿病合并肺炎克雷伯杆菌性肝脓肿的临床资料。结果糖尿病合并肺炎克雷伯杆菌性肝脓肿占同期收治糖尿病性细菌性肝脓肿的57.1%。临床主症有畏寒、发热、乏力,腹痛、肝区叩击痛。脓肿多为单发、局限于右肝。首诊确诊率仅37.5%,首次B超误诊率37.5%。本组在有效抗生素及B超引导下经皮肝脓肿穿刺抽脓/置管引流后均好转,无一例死亡。结论糖尿病并发肺炎克雷伯杆菌肝脓肿的临床表现不典型,易漏诊误诊。及时超声引导下行肝脓种穿刺引流,缩短疗程,预后佳。Abstract: Objctive to improve the clinical level of diagnosis and treatment in bacterial liver abscess in diabetics (DLA) caused by Klebsiella pneumoniae (Kp) .Methods Analyzing the clinical data of 16 cases of DLA caused by Kp during January 2001 and December 2008 in our hospital, including general characteristics, clinical manifestations, laboratory features and characteristics of liver abscess, treatments and outcomes.Results 16 cases of DLA caused by Kp were occupied by 57.1% of DLA.Clinical features were atypical, main symptoms included fever (87.5%) , anorexia (50%) , but the occurrence of the right upper abdominal Pain (31.2%) and hepatomegaly (18.8%) was not common (25%) .For characteristics of liver abscess, 76.5% abscess lay in right lobe of liver, solitary liver abscess and monomicrobial isolates were more frequent in the Kp patients.The ultrasound imaging features of hepatic abscess are intricate and variable, the misdiagnosis rate of our guoup was up to 37.5%.Percutaneous and transhepatic cholangiography drainage ofbacterial liver abscess can be used for most cases, which was simple and safe.Conclusion The clinical features of DLA caused by Klebsiella pneumoniae are atypical, might result in the difficulty of the diagnosis.B-Ultrasoundgraphy should be the first choice for diagnosis.It is important to early and routine examination Of B-ultrasound exemation.The method of percutaneous transhepatic drainage under ulreasonography for liver abscess is effective, safe, simple and shortened.
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Key words:
- Diabetics /
- bacterial liver abscess /
- Klebsiella pneumoniae /
- misdiagnosis
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