经内镜胆道金属支架置入术后胆道感染的原因及处理

Cause analysis and treatment of infection of biliary tract after endoscopic biliary metal stent drainage

目的 探讨经内镜胆道金属支架置入术后胆道感染的原因及处理方法.方法 回顾性分析2011年1月至2012年12月47例经内镜胆道金属支架引流患者的临床资料.结果 47例均一次成功置入胆道金属支架,6例肝门部胆管癌、3例胆管癌（胆总管）、2例壶腹癌以及1例肝移植术后吻合口狭窄患者在金属支架植入术后3周～31个月发生胆道感染,发生率为25.5％,包括4例肿瘤堵塞金属支架、3例胆泥及食糜淤积、3例急性化脓性胆囊炎以及2例肝脓肿,分别采取经皮经肝胆囊穿刺置管引流（PTGBD）、经皮经肝脓肿穿刺置管引流（PTCD）、经内镜球囊取石/覆膜金属支架及鼻胆管引流治疗,12例均治愈,未发生严重并发症.结论 胆泥及食糜淤积、肝脓肿、肿瘤长入支架、胆囊颈管开口受压是胆道金属支架置入术后胆道感染的主要原因,PTGBD、PTCD及治疗性ERCP是其主要治疗方法.

Objective To investigate the reasons and treatment of infection of biliary tract after endoscopic biliary metalstent drainage.Methods The clinical data of 47 cases who undergone the treatment of endoscopic biliary metal stent drainage （EBMSD） from Jan.2011 to Dec.2012 was analyzed retrospectively.Results All 47 cases were successfully implanted biliary metal stent.Six cases of hilar cholangiocarcinoma,3 cases of bile duct carcinoma （common bile duct）,2 cases of ampullary carcinoma and 1 case of anastomotic stricture after liver transplantation occurred infection of biliary tract in 3 weeks to 31 months after EBMSD,which including 4 cases of tumor ingrowth bracket,3 cases of biliary sludge and chyme siltation,3 cases of acute suppurative cholecystitis and 2 cases of liver abscess.All 12 cases were cured by percutaneous transhepatic gallbladder drainage （PTGBD）,percutaneous transhepatic cholangial drainage （PTCD）,endoscopic balloon stone extraction/covered metal stents and nasal biliary drainage.Conclusion Biliary sludge and chyme siltation,liver abscess,tumor ingrowth stent and the squeeze of gallbladder neck opening are the main reason of infection of biliary tract after EBMSD.PTGBD,PTCD and therapeutic ERCP are the main treatment.