PERCUTANEOUS DEBRIDEMENT OF COMPLEX PYOGENIC LIVER ABSCESSES

<正> The author's approach and technique in thetreatment of complex liver abscesses that persisted orrecurred following percutaneous drainage are des-cribed.Six patients were treated by percutaneousdebridement using an instrument specially designed forthat purpose.Four patients were chronically ill butstable,while the other two were septic,hypotensive andconsidered to be life threatened.All patients had pri-mary pyogenic abscesses.Four had demonstratedmixed bacterial flora consisting of E.coli,Klebsiella,Proteus and gram-positive cocci and two were causedby E.coli only.Contrast enhanced CT of the abdomenin all cases revealed multiloculated or septated ab-scesses containing large central debris and peripheralshell or halo of compromised hepatic parenchyma.Debridement was successful in all cases,resulting incomplete healing within 12 days.Follow-up for 1-4.5years revealed no recurrences.Three cases of infectedtumors of the liver were referred for treatment.CTfindings in these cases demonstrated a well developedexternal capsule and internal septations,and the ab-sence of a surrounding halo of compromisedparenchyma distinguishes them from primary ab-scesses.This preliminary experience makes the anthorsto conclude that percutaneous debridement of pyogenicliver abscesses is a safe and curative procedure in se-lected cases of life-threatening chronic liver abscesses.