肝切除で治癒したK．pneumoniae起因難治性肝膿瘍の1例
Klebsiella pneumoniae起因肝膿瘍に対して抗菌剤投与と経皮経肝膿瘍ドレナージ（percutaneous transhepatic abscess drainage;以下PTADと略記）の治療を行ったが，敗血症を併発したため保存的治療開始35日目に準緊急的に肝右葉切除術を行い，その後順調に経過した症例を報告した．今回の報告例のように保存的治療に抵抗性で外科治療を必要とする症例もいまだに存在する．細菌性肝膿瘍に対する手術適応の判断は困難であるが，画像診断の特徴（多発膿瘍，大きな膿瘍，隔壁により隔絶された膿瘍，厚い被膜を有する膿瘍，胆道病変の合併など），膿の性状（高い粘稠度），起因...
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| Published in | 日本臨床外科学会雑誌 Vol. 80; no. 2; pp. 392 - 398 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.80.392 |
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| Abstract | Klebsiella pneumoniae起因肝膿瘍に対して抗菌剤投与と経皮経肝膿瘍ドレナージ（percutaneous transhepatic abscess drainage;以下PTADと略記）の治療を行ったが，敗血症を併発したため保存的治療開始35日目に準緊急的に肝右葉切除術を行い，その後順調に経過した症例を報告した．今回の報告例のように保存的治療に抵抗性で外科治療を必要とする症例もいまだに存在する．細菌性肝膿瘍に対する手術適応の判断は困難であるが，画像診断の特徴（多発膿瘍，大きな膿瘍，隔壁により隔絶された膿瘍，厚い被膜を有する膿瘍，胆道病変の合併など），膿の性状（高い粘稠度），起因菌を総合的に考慮し，保存的治療が奏効しない場合には肝切除は速やかな回復が得られる有効な治療手段であり，細菌性肝膿瘍の治療にあたる際には選択肢の一つとして考慮しておくべきと考えられた． |
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| AbstractList | Klebsiella pneumoniae起因肝膿瘍に対して抗菌剤投与と経皮経肝膿瘍ドレナージ（percutaneous transhepatic abscess drainage;以下PTADと略記）の治療を行ったが，敗血症を併発したため保存的治療開始35日目に準緊急的に肝右葉切除術を行い，その後順調に経過した症例を報告した．今回の報告例のように保存的治療に抵抗性で外科治療を必要とする症例もいまだに存在する．細菌性肝膿瘍に対する手術適応の判断は困難であるが，画像診断の特徴（多発膿瘍，大きな膿瘍，隔壁により隔絶された膿瘍，厚い被膜を有する膿瘍，胆道病変の合併など），膿の性状（高い粘稠度），起因菌を総合的に考慮し，保存的治療が奏効しない場合には肝切除は速やかな回復が得られる有効な治療手段であり，細菌性肝膿瘍の治療にあたる際には選択肢の一つとして考慮しておくべきと考えられた． |
| Author | 伊地知, 正賢 柴崎, 正幸 阿部, 学 三浦, 英明 日下, 浩二 |
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| References | 23) 冨山恭行，大元謙治，吉岡菜穂子他:細菌性髄膜炎を合併し，胃瘻孔を形成した肝膿瘍の1切除例．日消誌 2007;104:1512-1518 22) Shiba H, Aoki H, Misawa T, et al : K. Pneumoperitoneum caused by ruptured gas-containing liver abscess. J Hepatobiliary Pancreat Surg 2007 ; 14 : 210-211 3) Alkofer B, Dufay C, Parienti JJ, et al : Are pyogenic liver abscess still a surgical concern ? A western experience. HPB Surg 2012 ; 2012 : 316013 ; doi : 10.1155/2012/316013 6) 木南伸一，桐山正人，藤田秀人他:ガス産生肝膿瘍に対し経皮経肝的ドレナージ後に外科的切除を適用した1例．日臨外会誌 2000;61:1536-1541 15) Pope JV, Teich DL, Clardy P, et al : Klebsiella pneumoniae liver abscess : an emerging problem in North America. J Emerg Med 2011 ; 41 : e103-105 12) Kirsner JB, Shorter RG : Recent development in nonspecific inflammatory bowel disease (second of two parts). N Engl J Med 1982 ; 306 : 837-848 25) 橘高弘忠，西本昌義，福田真樹子他:多発感染病巣を合併したクレブシエラ肝膿瘍の1例．日救急医会誌 2013;24:406-412 17) Fazili T, Sharngoe C, Endy T, et al : Klebsiella pneumoniae Liver Abscess : An Emerging Disease. Am J Med Sci 2016 ; 351 : 297-304 1) Malik AA, Bari SU, Rouf KA, et al : Pyogenic liver abscess : changing pattern in approach. World J Gastrointest Surg 2010 ; 2 : 395-401 19) Yeh KM, Kurup A, Siu LK : Capsular serotype k1 or k2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumonia liver abscess in Singapore and Taiwan. J Clin Microbiol 2007 ; 45 : 466-471 14) Lederman ER, Crum NF : Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen : an emerging disease with unique clinical characteristics. Am J Gastroenterol 2005 ; 100 : 322-331 20) Fang CT, Chuang YP, Shun CT, et al : A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004 ; 199 : 697-705 16) Moore R, O'Shea D, Geoghegan T, et al : Community-acquired Klebsiella pneumoniae liver abscess : an emerging infection in Ireland and Europe. Infection 2013 ; 41 : 681-686 9) Chou FF, Sheen-Chen SM, Chen YS, et al : Single and multiple pyogenic liver abscess : clinical course, etiology, and results of treatment. World J Surg 1997 ; 21 : 384-389 4) Christein JD, Kendrick ML, Que FG : What affect mortality after the operative management of hepatic abscess ? HPB(Oxford) 2006 ; 8 : 175-178 24) Morii K, Kashihara A, Miura S, et al : Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae. Clin J Gastroenterol 2012 ; 5 : 136-140 13) Cerwenka H : Pyogenic liver abscess : differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol 2010 ; 28 : 2458-2462 10) Tann YM, Chung AYF, Chow PKH : An appraisal of surgical and percutaneous drainage for pyogenic liver abscess lager than 5 cm. Ann Surg 2005 ; 241 : 485-490 7) 細川勇一，桂巻 正，木村康利他:肝切除術にて治癒した難治性肝膿瘍の1例．日臨外会誌 2002;63:657-660 5) 林 貴史，澤田 隆，清水 哲他:緊急肝切除により救命しえた糖尿病合併ガス産生化膿性肝膿瘍の1例．日臨外会誌 1999;60:1366-1369 11) Rintoul R, O'Riordain MG, Laurenson IF, et al : Changing management of pyogenic liver abscess. Br J Surg 1996 ; 83 : 1215-1218 21) Yu WL, Ko WC, Cheng KC : Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis 2006 ; 42 : 1351-1358 18) Siu LK, Yeh KM, Lin JC, et al : Klebsiella pneumoniae liver abscess : a new invasive syndrome. Lancet Infect Dis 2012 ; 12 : 881-887 2) Hope WW, Vrochides DV, Newcomb WL, et al : Optimal treatment of hepatic abscess. Am Surg 2008 ; 74 : 178-182 8) Strong RW, Fawcett J, Lynch SV, et al : Hepatectomy for pyogenic liver abscess. HPB(Oxford) 2003 ; 5 : 86-90 |
| References_xml | – reference: 21) Yu WL, Ko WC, Cheng KC : Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis 2006 ; 42 : 1351-1358 – reference: 2) Hope WW, Vrochides DV, Newcomb WL, et al : Optimal treatment of hepatic abscess. Am Surg 2008 ; 74 : 178-182 – reference: 8) Strong RW, Fawcett J, Lynch SV, et al : Hepatectomy for pyogenic liver abscess. HPB(Oxford) 2003 ; 5 : 86-90 – reference: 17) Fazili T, Sharngoe C, Endy T, et al : Klebsiella pneumoniae Liver Abscess : An Emerging Disease. Am J Med Sci 2016 ; 351 : 297-304 – reference: 14) Lederman ER, Crum NF : Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen : an emerging disease with unique clinical characteristics. Am J Gastroenterol 2005 ; 100 : 322-331 – reference: 15) Pope JV, Teich DL, Clardy P, et al : Klebsiella pneumoniae liver abscess : an emerging problem in North America. J Emerg Med 2011 ; 41 : e103-105 – reference: 20) Fang CT, Chuang YP, Shun CT, et al : A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004 ; 199 : 697-705 – reference: 6) 木南伸一，桐山正人，藤田秀人他:ガス産生肝膿瘍に対し経皮経肝的ドレナージ後に外科的切除を適用した1例．日臨外会誌 2000;61:1536-1541 – reference: 10) Tann YM, Chung AYF, Chow PKH : An appraisal of surgical and percutaneous drainage for pyogenic liver abscess lager than 5 cm. Ann Surg 2005 ; 241 : 485-490 – reference: 25) 橘高弘忠，西本昌義，福田真樹子他:多発感染病巣を合併したクレブシエラ肝膿瘍の1例．日救急医会誌 2013;24:406-412 – reference: 3) Alkofer B, Dufay C, Parienti JJ, et al : Are pyogenic liver abscess still a surgical concern ? A western experience. HPB Surg 2012 ; 2012 : 316013 ; doi : 10.1155/2012/316013 – reference: 22) Shiba H, Aoki H, Misawa T, et al : K. Pneumoperitoneum caused by ruptured gas-containing liver abscess. J Hepatobiliary Pancreat Surg 2007 ; 14 : 210-211 – reference: 1) Malik AA, Bari SU, Rouf KA, et al : Pyogenic liver abscess : changing pattern in approach. World J Gastrointest Surg 2010 ; 2 : 395-401 – reference: 16) Moore R, O'Shea D, Geoghegan T, et al : Community-acquired Klebsiella pneumoniae liver abscess : an emerging infection in Ireland and Europe. Infection 2013 ; 41 : 681-686 – reference: 23) 冨山恭行，大元謙治，吉岡菜穂子他:細菌性髄膜炎を合併し，胃瘻孔を形成した肝膿瘍の1切除例．日消誌 2007;104:1512-1518 – reference: 12) Kirsner JB, Shorter RG : Recent development in nonspecific inflammatory bowel disease (second of two parts). N Engl J Med 1982 ; 306 : 837-848 – reference: 11) Rintoul R, O'Riordain MG, Laurenson IF, et al : Changing management of pyogenic liver abscess. Br J Surg 1996 ; 83 : 1215-1218 – reference: 24) Morii K, Kashihara A, Miura S, et al : Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae. Clin J Gastroenterol 2012 ; 5 : 136-140 – reference: 7) 細川勇一，桂巻 正，木村康利他:肝切除術にて治癒した難治性肝膿瘍の1例．日臨外会誌 2002;63:657-660 – reference: 9) Chou FF, Sheen-Chen SM, Chen YS, et al : Single and multiple pyogenic liver abscess : clinical course, etiology, and results of treatment. World J Surg 1997 ; 21 : 384-389 – reference: 13) Cerwenka H : Pyogenic liver abscess : differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol 2010 ; 28 : 2458-2462 – reference: 18) Siu LK, Yeh KM, Lin JC, et al : Klebsiella pneumoniae liver abscess : a new invasive syndrome. Lancet Infect Dis 2012 ; 12 : 881-887 – reference: 4) Christein JD, Kendrick ML, Que FG : What affect mortality after the operative management of hepatic abscess ? HPB(Oxford) 2006 ; 8 : 175-178 – reference: 19) Yeh KM, Kurup A, Siu LK : Capsular serotype k1 or k2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumonia liver abscess in Singapore and Taiwan. J Clin Microbiol 2007 ; 45 : 466-471 – reference: 5) 林 貴史，澤田 隆，清水 哲他:緊急肝切除により救命しえた糖尿病合併ガス産生化膿性肝膿瘍の1例．日臨外会誌 1999;60:1366-1369 |
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| Snippet | Klebsiella pneumoniae起因肝膿瘍に対して抗菌剤投与と経皮経肝膿瘍ドレナージ（percutaneous transhepatic abscess... |
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| SubjectTerms | Klebsiella pneumoniae 細菌性肝膿瘍 肝切除術 |
| Title | 肝切除で治癒したK．pneumoniae起因難治性肝膿瘍の1例 |
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