逆行胰胆管造影前内镜孔道酸化水消毒与术后感染的关系研究

Relation of endoscopic biopsy channel disinfection with electrolyzed oxidizing water before ERCP cannulation with post-operative infection.

目的观察内镜孔道的消毒与内镜逆行胰胆管造影(ERCP)术后感染发生的关系。方法选择2010年3月至7月北京友谊医院收治的胆胰疾病患者58例,随机分成ERCP插管前经内镜孔道酸化水消毒组(实验组)和常规ERCP插管组(对照组),每组29例。实验组在乳头插管前用酸化水20 mL冲洗内镜孔道2次。操作结束后,两组均在活检孔道内注入10 mL生理盐水,在内镜头端应用无菌试管接收活检孔道流出液体,行常规细菌培养。结果 58例患者均成功行ERCP治疗。其中实验组患者6.9%(2/29)术后出现发热,经抗感染治疗后体温降至正常、黄疸消退。内镜孔道细菌培养19例培养标本有细菌生长;对照组患者27.6%(8/29)出现术后发热,其中发生化脓性胆管炎2例,行再次ERCP治疗。对照组29例标本均有细菌生长。结论 ERCP插管前行酸化水内镜孔道再次消毒可减少术后感染的发生。

Objective To evaluate the relation of endoscopic biopsy channel disinfection with electrolyzed oxidizing water（EOW） before ERCP cannulation and postoperative infection. Methods Data were collected from 58 patients who had undergone therapeutic ERCP during March 2010 and July 2010 in Gastro-enterologic Endoscopy Center of the Beijing Friendship Hospital. Patients were divided randomly into EOW disinfection group （ n = 29） and Control group （ n = 29）. In EOW disinfection group, the endoscopic biopsy channel and area around the papilla were rinsed with 20 mL EOW twice before eannulation. Specimens were obtained from endoscopic biopsy channel by rinsing with 10 mL of saline immediately after being used for bacterial culture. Results All the 58 patients were successfully operated in one performance, Compared with the control group, EOW group had a lower in- cidence of fever after operation （ 6. 9 % vs 27. 6 % , P 〈 0. 05 ）. None of the patients in EOW group and two in control group had suppurative cholangitis. Nineteen specimens were bacteria positive in EOW group, and all 29 specimens from the control group were bacteria positive（19/29 vs 29/29,P 〈0. 01 ）. Conclusion Endoscopic biopsy channel disinfection with EOW before ERCP cannulation is effective in reducing postoperative infection.