[摘要]目的：总结分析
糖尿病合并细菌性肝
脓肿（dla）的临床特点，并探讨其诊疗策略。方法：对19例糖尿病合并细菌性
肝脓肿（dla）患者的临床资料进行回顾性归纳分析。观察指标包括临床表现、并发症、实验室检查、病原学检查、脓肿分布以及治疗方法和疗效。结果：19例dla均为2型糖尿病患者，多见于血糖控制不良的老年人。临床表现不典型，明显
腹痛并不常见（26.3％），细菌培养阳性率低（36.8％）。b超、ct等影像学检查意义重大。单纯抗生素治疗13例，b超下脓肿穿刺5例，外科脓肿切开引流1例。18例康复，治疗总有效率达94.8％。结论：糖尿病合并细菌性肝脓肿临床表现复杂，并发症多，易漏诊、误诊。早期诊断、用胰岛素控制血糖、早期足量应用有效抗生素及适时脓肿引流是成功治疗的关键。
[关键词]糖尿病；细菌性肝脓肿；dla；诊断；治疗
[中图分类号]r587[文献标识码]a[文章编号]1673-7210（2007）12（b）-038-03
thediagnosisandtreatmentofbacterialliverabscessindiabetics:clinicalanalysisof19cases.
wangyong-di,songzhen-he,liufeng,chejin-ling
（theweihaimunicipalhospitalofshandongprovince,weihai264200,china）
[abstract]objective:toinvestigatetheclinicalcharacteristicsandtherapeuticstrategyofbacterialliverabscessindiabetics（dla）.methods:19casesofdlawereretrospectivelyreviewed.thefactorswhichweanalysedwereincludedamongtheclinicalpresentation,theotherdiseasescompaniedwithdla,thegenerallaboratoryexamination,bacterialculture,thepositionofabscessinliver,thetherapeuticmethodsandcurativeeffectoftreatment.results:19casesofdlawerealltype2diabetesmellitus,anddlaoccurredmorefrequentlyinelderlypatientswithhyperglycemia.clinicalfeaturesofthisdisorderwereatypical，theoccurrenceoftherightupperabdominalpainwasnotcommon.thepositiverateofbacteriacultivationinblood,puncturefluidsandothersourceswaslower（36.8%）.theb-ultrasonographyandcomputertomographyofliverplayedanimportantroleinthediagnosisofdla.13casesweretreatedbyantibioticsalong,5casessubmittedtoaspirationbytheguidingofb-ultrasonography,and1caseunderwentsurgicaldrainageofliverabscess.among19cases,18ofthemwerecurvedsuccessfully.conclusion:theclinicalfeaturesofdlaareatypical,andalsocompaniedwithmanycomplications,whichmightresultinthedifficultyofthediagnosisofdla.appropriatetherapeuticstrategiesincludeearlydiagnosis,controlofhyperglycemiawithinsulin,sufficientusecourseofantibioticsandtimelydrainageofabscess.
[keywords]diabetesmellitus;bacterialliverabscess;dla;diagnosis;treatment
细菌性肝脓肿（bacterialliverabscess）多由血行感染、
胆道感染或邻近组织感染所引起，近年来，随着诊疗技术的进步和有效抗生素的广泛使用，隐源性肝脓肿的发生率有上升趋势，文献报道从2％到53.3％不等，该类患者常伴有免疫功能低下和全身代谢性疾病，而其中有25％伴有糖尿病[1]，尤其对城市居民而言，糖尿病已成为诱发肝脓肿不可忽视的原因之一。
