| 特集名 | 感染症と肝 | |
|---|---|---|
| 題名 | 細菌感染症と肝 (1) 肝膿瘍の成因と治療 | |
| 発刊年月 | 2001年 04月 | |
| 著者 | 林 茂樹 | 国立国際医療センター消化器科 |
| 著者 | 山下 浩子 | 国立国際医療センター消化器科 |
| 【 要旨 】 | 肝膿瘍は，感染経路により経胆道性，経門脈性，経動脈性，直達性，外傷性，特発性に大別でき，経胆道性がもっとも多い．また起因菌については好気性グラム陰性菌が多く，とくにKlebsiella pneumoniaeやEscherichia coliが多い．また嫌気性菌や複数菌感染の関与も認められる． 肝膿瘍は，過去において致死率の高い疾患であったが，近年診断能の向上と薬物療法の進歩，さらに膿瘍ドレナージなどにより致死率は低下している．現在の肝膿瘍の治療の主流は，抗生物質の全身投与と膿瘍ドレナージである．開腹下ドレナージは特殊な合併症を有する場合に限られる． |
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| Theme | Liver in Infection Diseases | |
|---|---|---|
| Title | Etiology and Treatment of Pyogenic Liver Abscesses | |
| Author | Shigeki Hayashi | Department of Gastroenterology, International Medical Center of Japan |
| Author | Hiroko Yamashita | Department of Gastroenterology, International Medical Center of Japan |
| [ Summary ] | For the treatment of pyogenic liver abscesses, it is very important to know both the most common route of infection and the responsible microorganism. The leading route of infection in pyogenic liver abscesses is through the biliary tract, followed by the portal vein. Other routes, such as through the hepatic artery, direct extension and cases of abdominal trauma, are quite rare. Gram-negative bacilli, such as Klebsiella pneumoniae and Escherichia coli are often detected in infected bile. After the introduction of systemic administration of appropriate antibiotics and ultrasound-guided percutaneous transhepatic abscess drainage (US-PTAD), the mortality rate has decreased to nearly zero. There is still some controversy as to when administration of antibiotics should be stopped, and in to what size of abscess US-PTAD should be introduced. Controlled trials should be performed to answer these questions. |
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