Analysis of the therapeutic effect and influence factors on percutaneous catheter drainage with continuous instillation for the treatment of bacterial liver abscess with diabetes mellitus
XU Shihao, YING Li, LI Qiao, LIN Tuo, HU Yuanping.
Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015
XU Shihao,YING Li,LI Qiao, et al. Analysis of the therapeutic effect and influence factors on percutaneous catheter drainage with continuous instillation for the treatment of bacterial liver abscess with diabetes mellitus[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2016, 46(5): 359-364.
Abstract：Objective: To compare the clinical value of two methodes of ultrasound guided percutaneous catheter drainage for the treatment of bacterial liver abscess with diabetes mellitus (continuous instillation and simple catheter drainage). Furthermore, the factors which could influence the postoperative extubation time and length of hospital stay were also identified. Methods: One hundred and seventy cases of diabetic patients with bacterial liver abscess were randomly divided into 2 groups, which were all under the ultrasound interventional treatment. Eighty-five patients underwent simple catheter drainage, and 85 patients underwent continuous instillation. Patients were followed up to assess the postoperative complications, postoperative body temperature and peripheral blood leukocyte returned to normal time, postoperative extubation time, and length of hospital stay. The factors which could influence the postoperative extubation time and length of hospital stay were also identified in instillation group, in which 85 cases underwent continuous instillation by ultrasound guided percutaneous hepatic puncture. In addition, a multicomponent prediction model for predicting postoperative extubation time and length of hospital stay were developed using LASSO regression. Results: There was no statistically significant between the two groups regarding the incidence of postoperative complications, peripheral blood leukocyte and postoperative body temperature returned to normal time (P>0.05). Postoperative extubation time in instillation group was (21.1±12.4) d, significantly shorter than that in drainage group (29.1±14.9) d (P<0.05), hospitalization time in instillation group was (16.2±6.6) d, also significantly shorter than that in drainage group (27.8±8.0) d (P<0.05). The influence factors of postoperative extubation time is: abscesses gas, locule number, combined biliary calculi, plasma albumin and body mass index (BMI) (P<0.05); The only influence factor for postoperative hospital stay was septic shock (P<0.05). The multicomponent prediction model for predicting postoperative extubation time=0.06 leukocyte -0.72 albumin+1.99 more room+6.86 biliary stones+0.94 BMI; postoperative hospital stay=0.21 triacylglycerol +1.79 septic shock. Conclusion: Continuous instillation was more effective than simple catheter drainage in the treatment of diabetic bacterial liver abscess. Ultrasound image characteristics of abscesses gas, locule number, patients with biliary calculi, hypoalbuminemia or high BMI will extend the postoperative extubation time, merge patients with septic shock will extend the postoperative hospital stay.
