한국인간농양의 임상적 고찰

Abstract

[영문]

Professor Ludlow of Severance Union Medical College was the first to report (1923) the fact that hepatic abscess in a Korean patient produced clinical signs and symptoms which were somewhat different from those found among occidentals who stayed in the peninsula.

Following the advent and subsequent wide use of chemotherapeutic drugs and antibiotics, the incidence of hepatic abscess has decrease along with its mortality rate.

Event thought this condition is becoming rare, it is an insidious one. The alert clinician who considers the possibility of an hepatic abscess in his differential diagnosis, and who recognizes the condition in time to give adequate early treatment, can frequently prevent the patient's death. Too many patients are seen only after a long period of neglect, and at a time that adequate treatment is not effective.

During the last 10 years the incidence of hepatic abscess among Koreans and occidentals has been the same.

Every Korean surgeon will occasionally operate upon patients who have hepatic abscesses. However, as yet, there is no report of a systematic study of patients presenting this problem since Ludlow. The purpose of this study is to provide a statistical analysis of this problem and a knowledge of the clinical behaviour of hepatic abscess in Korea, there with providing material which can be used in comparing similar studies made in other countries.

MATERIALS

The case histories of 87 patients admitted to Severance Hospital, Yonsei University Medical Center from July 1, 1955 to June 30, 1965 were reviewed. Each patient had a diagnosis is hepatic abscess. 61 had surgery. 26 patients had their diagnosis confirmed by non-surgical measures such as X-Ray examination.

RESULTS

1. Among 61 cases coming to surgery 28 (46%) were due to pyogenic infection 33 (54%) were amoebic in origin.

2. In both types of abscesses males outnumbered females in a 4:1 ratio.

3. The peak age incidence for both types came in the 4th decade (30-40 years).

4. The right lobe was involved in 86% of the pyogenic and 97% of the amoebic abscesses. The left lobe was involved in 14% of the pyogenic and only 3% of the amoebic abscesses.

5. In direct smear and culture studies the pus was found to be sterile in 32% of the abscesses. 36% showed Gram-negative cocci (the commonest organism found), and 18% had coagulase-positive staphylococci.

6. Only 15% of the amoebic abscesses showed Endamoeba Histolytica in the abscess, and only 4% had amoeba in their stools.

7. 8% of the patients with pyogenic abscess showed abnormal liver function, but 89% of those with amoebic abscess were found to have hepatic dysfunction.

8. 78% of the patients with pyogenic abscess had positive X-Ray findings and in amoebic abscess positive signs were present in 82%.

9. Pyogenic hepatic abscess was treated with pre and post-operative antibiotics, while emetine hydrochloride and chloroquine were the drugs of choice for the amebic abscess. Surgical drainage was used for both types.

10. 7% of the pyogenic, and 24% of the amebic abscess patients developed complications.

11. 4.9% of the 61 patients having surgical exploration or treatment died. This is mortality of 3.6% for the pyogenic and 6% for the amoebic abscess patients.

CONCLUSION

With adequate surgical drainage and the use of chemotherapeutic drugs and antibiotics as indicated the prognosis for hepatic abscess patients is good. The physician must always consider the possibility of an hepatic abscess in making the differential diagnosis for any patient who has chills and fever of obscure origin.