肝脏及胆管术后胆瘘合并腹腔感染的诊疗分析

Diagnosis and treatment of biliary fistula complicated with abdominal infection after liver or biliary surgery

目的探讨肝脏及胆管术后胆瘘合并腹腔感染患者的诊断与治疗方法。方法 387例肝胆外科手术的患者,其中胆瘘31例,胆瘘合并腹腔感染14例。对临床上怀疑胆瘘合并腹腔感染的患者行血液及引流液培养、腹部CT等检查,一经确诊,即给予穿刺引流、抗生素等综合治疗措施。结果 14例胆瘘合并腹腔感染的患者中,共培养出阳性菌19例次,其中粪肠球菌感染8例次(42.1%),大肠埃希菌感染7例次(36.8%),腐败希瓦菌感染2例次(10.5%),弗氏柠檬酸杆菌感染1例次(5.3%),热带念珠菌感染1例次(5.3%),患者经治疗后好转13例,死亡1例。结论对胆瘘合并腹腔感染患者,影像学检查及病原学检查尤为重要,穿刺引流术是治疗的有效措施。

Objective To study the methods of diagnosis and treatment of biliary fistula complicated with abdominal infection. Methods We analyzed the clinical data of 387 patients,among whom 31 cases were diagnosed of biliary fistula and 14 cases were diagnosed of biliary fistula complicated with abdominal infection. The patients who were afraid of biliary fistula complicated with abdominal infection was diagnosed by examining funga in blood ,fluid,and image examination （such as abdominal CT scan）. Those who were diagnosed with biliary fistula complicated with abdominal infection would be treated by puncture drainage and antibiotics. Results Nineteen pathogenic strains were isolated from 14 patients. Enterococcus faecalis infection was diagnosed in 8 strains （42.1%）,Escherichia coli infection was diagnosed in 7 strains （36.8%）,Shewanella putrefaciens infection was diagnosed in 2 strains（10.5%）,Citrobacter freundii infection was diagnosed in 1 strains （5.3%）,and Candida tropicalis infection was diagnosed in 1 strains （5.3%）. Thirteen patients were cured,and one patient died. Conclusions Image examination and funga examination were the most important methods in the diagnosis of biliary fistula complicated with abdominal infection. The best therapy is puncture drainage.