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文献考察１）：孤立性（343例）と多発性肝膿瘍（140例）．
World J Surg. 1997 May;21(4):384-8; discussion 388-9.
Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment.
Chou FF, Sheen-Chen SM, Chen YS, Chen MC.
Department of Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung Medical School, Taiwan, Republic of China.
A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.PMID: 9143569
文献考察２）：多発性肝膿瘍には抗生物質の動注が有効
難治性多発性肝膿瘍に間欠的動注化学療法が著効した1例
Author：安藤勤(四国中央病院 外科), 田上誉史, 三宅秀則, 田代征記
Source：外科(0016-593X)64巻11号 Page1356-1360(2002.11)
Abstract：63歳女性.難治性多発性肝膿瘍に間欠的動注化学療法が著効した1例を経験した.閉塞性黄疸で入院した.PTBD施行後に造影CTで膵頭部癌と診断して膵頭十二指腸切除術を施行し,肝表面に多発肝転移を認めた.術後第20病日から38℃以上の高熱が出現し,CTおよび超音波検査で内側区域の肝膿瘍と診断して,経皮経肝肝膿瘍ドレナージ(PTAD)を施行し軽快したが,第36病日から再度高熱が出現し,後区域の肝膿瘍と診断してPTADを再施行し解熱・軽快した.しかし,第48病日からまた高熱が出現し,造影CTでは前区域に多発性肝膿瘍が認められ,全身化学療法を施行したが改善せず,第60病日に腹腔動脈内に動注用カテーテルを挿入し,リザーバーに接続して間欠的動注化学療法を行った.施行後急速に解熱,自他覚症状の改善,CRPも著明に低下し,術後94日目に軽快退院した.動注化学療法は肝膿瘍に対する効果的な治療法であると考えられた．
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