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细菌性肝脓肿诊治急诊专家共识
中华医学会急诊医学分会
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DOI： 10.3760/cma.j.issn.1671-0282.2022.03.003
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摘要

肝脓肿（liver abscess, LA）是致病菌通过胆道、肝动脉、门静脉、直接蔓延等途径侵入肝脏引起的肝内局灶性、化脓性病变，是临床上常见的消化系统感染性疾病之一。LA常见病原菌包括细菌、真菌、阿米巴，其中细菌性肝脓肿（pyogenic liver abscess, PLA）最常见，占肝脓肿发病率的80% [1]。PLA临床主要表现为发热、腹痛、白细胞及C反应蛋白等炎症指标升高，但也有部分患者腹部症状及体征不明显，体格检查缺乏特异性，容易造成漏诊、误诊。随着医学技术的进展，PLA的诊断率与治愈率已显著提高，死亡率已低至10%以下。但近年来随着糖尿病、恶性肿瘤、使用免疫抑制等患者增多，临床上肝胆有创操作增多，以及多重耐药和高毒力致病菌株的产生，PLA的病因、病原体和临床表现发生相应变化，给临床诊治工作带来了新的挑战；同时随着介入治疗的发展及应用，PLA治疗策略也发生了变化。急诊科作为肝脓肿首诊的主要科室之一，临床诊治工作须做到快速、高效且精准。本共识旨在通过回顾细菌性肝脓肿相关临床研究和指南、整合专家意见、结合急诊诊疗具体情况等来进行制定。

引用本文

中华医学会急诊医学分会. 细菌性肝脓肿诊治急诊专家共识[J]. 中华急诊医学杂志,2022,31(03)：273-280.

DOI:10.3760/cma.j.issn.1671-0282.2022.03.003

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肝脓肿（liver abscess, LA）是致病菌通过胆道、肝动脉、门静脉、直接蔓延等途径侵入肝脏引起的肝内局灶性、化脓性病变，是临床上常见的消化系统感染性疾病之一。LA常见病原菌包括细菌、真菌、阿米巴，其中细菌性肝脓肿（pyogenic liver abscess, PLA）最常见，占肝脓肿发病率的80% [ 1 ]。PLA临床主要表现为发热、腹痛、白细胞及C反应蛋白等炎症指标升高，但也有部分患者腹部症状及体征不明显，体格检查缺乏特异性，容易造成漏诊、误诊。随着医学技术的进展，PLA的诊断率与治愈率已显著提高，死亡率已低至10%以下。但近年来随着糖尿病、恶性肿瘤、使用免疫抑制等患者增多，临床上肝胆有创操作增多，以及多重耐药和高毒力致病菌株的产生，PLA的病因、病原体和临床表现发生相应变化，给临床诊治工作带来了新的挑战；同时随着介入治疗的发展及应用，PLA治疗策略也发生了变化。急诊科作为肝脓肿首诊的主要科室之一，临床诊治工作须做到快速、高效且精准。本共识旨在通过回顾细菌性肝脓肿相关临床研究和指南、整合专家意见、结合急诊诊疗具体情况等来进行制定。
共识采用共识会议法制订，过程包括：题目的选定、成立编写小组、提出关键问题、系统检索整理相关文献、撰写共识初稿。初稿提交编写组专家函审，提出修改意见，修订后召开专家讨论会，确定终稿，再次提交共识编写组专家审核定稿，最终专家组成员得出一致性程度较高的推荐意见 [ 2 ]。
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上海市科委临床医学创新研究 (20Y11900100)
上海市申康临床医学研究 (SHDC2020CR4059)
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