介入治疗梗阻性黄疸患者胆道感染的影响因素分析
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摘要
目的探讨采取介入治疗的梗阻性黄疸患者并发胆道感染的影响因素。方法选取2013年1月-2017年12月于医院行介入治疗的恶性梗阻性黄疸患者218例为研究对象,观察患者感染的情况,对患者性别、年龄,术式等临床资料进行分析,归纳介入治疗梗阻性黄疸患者胆道感染的影响因素。结果术后发生胆道感染患者33例,感染率为15.14%,20例患者的胆汁样本中检出病原菌,检出率为60.61%,共培养分离病原菌25株,其中革兰阴性菌16株占64.00%,以大肠埃希菌、铜绿假单胞菌为主;革兰阳性菌9株占36.00%,为粪肠球菌和屎肠球菌。经内镜鼻胆管引流术(ENBD)、经皮肝穿刺胆道引流(PTCD)及经内镜逆行性胰胆管造影术(ERCP)支架植入的梗阻性黄疸患者的术后胆道感染率分别为13.48%、15.85%和17.02%,差异无统计学意义(P=0.839)。胆道感染史、术前黄疸天数、术后胆汁引流是介入治疗梗阻性黄疸患者胆道感染的影响因素(P<0.001)。结论梗阻性黄疸介入治疗术后胆道感染与多种因素有关,临床应对影响因素进行全面的评价和有效地干预,以达到降低术后感染、确保治疗效果、改善患者预后的目的。
OBJECTIVE To probe the influencing factors of biliary tract infections after interventional therapy in the patients with obstructive jaundice.METHODS 218 patients with malignant obstructive jaundice undergoing interventional therapy from Jan.2013 to Dec.2017 were selected as the research subjects.The occurrence of biliary tract infections after interventional therapy of the patients was observed.The clinical data such as gender,age and operation mode were analyzed.The influencing factors of postoperative biliary infections in the patients with obstructive jaundice after interventional therapy were analyzed.RESULTS 33 patients were observed with postoperative biliary tract infection,and the infection rate was 15.14%.The pathogenic bacteria were detected in the bile samples of 20 patients,with a detection rate of 60.61%.25 strains of pathogenic bacteria were detected,among them,16 strains were gram-negative bacteria accounting for 64.00%,mainly including Escherichia coli and Pseudomonas aeruginosa,and 9 strains were gram-positive bacteria accounting for 36.00%,mainly including Enterococcus faecalis and Enterococcus faecalis.The incidences of postoperative biliary tract infections in the patients with obstructive jaundice who underwent endoscopic nasobiliary drainage(ENBD),percutaneous transhepatic biliary drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)were 13.48%,15.85% and17.02%,there was no significant difference(P=0.839).The influencing factors of biliary tract infections after interventional therapy in the patients were history of biliary infection,preoperative jaundice duration,and postoperative biliary drainage(P<0.001).CONCLUSIONThe incidence of biliary tract infections after interventional therapy of the patients with obstructive jaundice was related to many factors.The clinicians should employ comprehensive evaluation and effective intervention according to these risk factors,so as to reduce the postoperative infection,ensure the treatment effects and improve the prognosis of the patients.
OBJECTIVE To probe the influencing factors of biliary tract infections after interventional therapy in the patients with obstructive jaundice.METHODS 218 patients with malignant obstructive jaundice undergoing interventional therapy from Jan.2013 to Dec.2017 were selected as the research subjects.The occurrence of biliary tract infections after interventional therapy of the patients was observed.The clinical data such as gender,age and operation mode were analyzed.The influencing factors of postoperative biliary infections in the patients with obstructive jaundice after interventional therapy were analyzed.RESULTS 33 patients were observed with postoperative biliary tract infection,and the infection rate was 15.14%.The pathogenic bacteria were detected in the bile samples of 20 patients,with a detection rate of 60.61%.25 strains of pathogenic bacteria were detected,among them,16 strains were gram-negative bacteria accounting for 64.00%,mainly including Escherichia coli and Pseudomonas aeruginosa,and 9 strains were gram-positive bacteria accounting for 36.00%,mainly including Enterococcus faecalis and Enterococcus faecalis.The incidences of postoperative biliary tract infections in the patients with obstructive jaundice who underwent endoscopic nasobiliary drainage(ENBD),percutaneous transhepatic biliary drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)were 13.48%,15.85% and17.02%,there was no significant difference(P=0.839).The influencing factors of biliary tract infections after interventional therapy in the patients were history of biliary infection,preoperative jaundice duration,and postoperative biliary drainage(P<0.001).CONCLUSIONThe incidence of biliary tract infections after interventional therapy of the patients with obstructive jaundice was related to many factors.The clinicians should employ comprehensive evaluation and effective intervention according to these risk factors,so as to reduce the postoperative infection,ensure the treatment effects and improve the prognosis of the patients.
引文
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[11]成丕光,王建强,石天亭,等.梗阻性黄疸患者经皮肝穿胆道引流术后胆道感染的分析[J].中华医院感染学杂志,2016,26(12):2753-2755.
[12] Ikeuchi N,Itoi T,Tonozuka R,et al.Strongyloides stercoralis infection causing obstructive jaundice and refractory pancreatitis:a lesson learned from a case study[J].Intern Med,2016,55(15):2081-2086.
[2] Moole H,Bechtold M,Puli SR.Efficacy of preoperative biliary drainage in malignant obstructive jaundice:a meta-analysis and systematic review[J].World J Surg Oncol,2016,14(1):182.
[3] Tang K,Sui LL,Xu G,et al.Effects of different palliative jaundice reducing methods on immunologic functions in patients with advanced malignant obstructive jaundice[J].Anticancer Res,2017,37(8):4665-4670.
[4] Antonini F,Macarri G.Endoscopic ultrasound for the diagnosis of an uncommon cause of obstructive jaundice masquerading as malignancy[J].Endosc Ultrasound,2017,6(4):276-277.
[5]陈灏珠.实用内科学[M].第12版,北京:人民卫生出版社,2005:5.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7] Agrawal GN,Shevade SU.Comparison of Clinical and Laboratory Standards Institute 2008and 2010guidelines in interpreting susceptibility of enterobacteriaceae isolates[J].Indian J Pathol Microbiol,2014,57(3):518-519.
[8] Imam S,Islam MN,Khan NA,et al.Magnetic resonance cholangiopancreatography(MRCP)evaluation of obstructive jaundice in comparison with endoscopic retrograde cholangiopancreatography(ERCP)[J].Mymensingh Med J,2017,26(2):420-425.
[9] Hwang HE,Tseng HS,Liu CA,et al.Hepatobiliary and pancreatic:obstructive jaundice after transarterial chemoembolization of hepatocellular carcinoma related to intraductal tumor necrotic fragment[J].J Gastroenterol Hepatol,2017,32(3):546.
[10]夏卿,周新锋,范晓翔,等.梗阻性黄疸患者经皮经肝胆道引流术后胆道感染相关因素研究[J].中华医院感染学杂志,2017,27(17):3960-3963.
[11]成丕光,王建强,石天亭,等.梗阻性黄疸患者经皮肝穿胆道引流术后胆道感染的分析[J].中华医院感染学杂志,2016,26(12):2753-2755.
[12] Ikeuchi N,Itoi T,Tonozuka R,et al.Strongyloides stercoralis infection causing obstructive jaundice and refractory pancreatitis:a lesson learned from a case study[J].Intern Med,2016,55(15):2081-2086.