간농양의 임상적 고찰

• Published in: The Korean journal of gastroenterology Vol. 26; no. 3; pp. 506 - 520
• Main Authors: 이옥재, Ok Jae Lee, 김영채, Young Chai Kim
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 01.01.1994
• Subjects: Abdominal ultrasonography; CT scan; Liver abscess
• ISSN: 1598-9992

Liver abscess had been described as fatal disease before the turn of the century. There are two kinds of liver abscess, the etiology, clinical course, diagnosis, and management are different be- tween pyogenic and arnebic abscess. With the advent of antibiotics and the development of newer imaging t,echniques, marked changes in diagnosis, treatment and prognosis have been reported. In this study, a detailed review was perforrned in 74 patients treated for pyogenic or amebic liver abscess at the Gyeongsang I%ational University Hospital frorn January, 1987 through June, 1993. Among 74 cases of liver abscess, 66(89.2%) were pyogenic and 8(10.8%) amebic. The male to female ratio of liver abscess was 1.1:1 in pyogenic, 7:1 in amebic, the peak inci- dence was in the 6th decade in pyogenic and 5th, 6th decade in amebic abscess. The rnost com mon portal of entry in pyogenic abscess was biliary tract(71.2%). Liver scan, abdominal ul- trasound and CT scan was performed in 18.9%, 100%, 77% each with the each positive rate was 100%, 81.1%, and 98.2%. The most common organism of the pyogenic abscess was E. coli(46.3%). Secondary infection of amebic abscess was occurred in 1 case(12.5%). 1n the amebic abscess, antibody t.o ameba was positive in 6 cases(75%) and pus revealed chocolate brown or anchovy paste like color in 7 cases(87.5%). In the pyogenic abscess, su.'gical drain- age, percutaneous drainage or antibiotics alone was tried in 50.2%, 25.8%, 21.2% E.'ach and the each cure rate was 89.5%, 88.6% and 28.6%. The patients with amebic abscess were cured by amebicides alone(62.5%) or percutaneous aspiration(37.5%). The mortality rate of liver abscess was 12.1% in pyogenic and 0% in amebic. The factors influencing mortality in the pyogenic abscess were nonbliary origin, underlying malignancy, multiplicity of abscess, large abscess cavity(>10cm), involvement of both lobe and hypoalburninemia(K3g/dl).(Ko rean J Gastroenterol 1994; 26: 506 520)