PHẪU THUẬT NỘI SOI ĐIỀU TRỊ ÁP XE GAN VỠ TRONG Ổ BỤNG

Abstract

Background: Pyogenic liver abscess (PLA) is a severe hepatic infection with high mortality if undiagnosed or untreated, particularly when ruptured into the peritoneal cavity causing acute peritonitis. Laparoscopic surgery has increasingly replaced open surgery due to its minimally invasive nature and faster recovery.​ Methods: A cross-sectional descriptive study was conducted on 30 patients with ruptured liver abscess into the peritoneal cavity who underwent laparoscopic surgery at the Department of Hepato-Pancreato-Biliary Surgery, Chợ Rẫy Hospital, from January 2023 to August 2025. Results: The mean age was 56.6 ± 10.6 years. Males accounted for 63.3%. Diabetes mellitus (DM) was the most frequent underlying disease (56.7%). Typical symptoms included abdominal pain (100%), fever (56.7%), and anorexia (23.3%). Imaging showed abscesses primarily in the right lobe (53.3%), with 80% of cases having a size ≥ 5 cm. The main pathogen was Klebsiella pneumoniae (50%). The mean operative time was 119.0 ± 25.6 minutes, with a 100% success rate. The mean postoperative stay was 7.3 ± 1.6 days. Correlation analysis: abscess size ≥5 cm significantly prolonged operative time (p = 0.027) and increased the risk of generalized peritonitis by 8.4 times (p = 0.009). Right lobe location resulted in longer operative time (p = 0.014) and a 6.1-fold higher risk of generalized peritonitis (p = 0.037). No significant association was found between abscess characteristics and postoperative complications. Conclusion: Laparoscopic surgery is a safe and effective method for ruptured PLA. Abscess size and location are critical prognostic factors for surgical difficulty and the severity of peritonitis.