ERCP术后发生胆道感染的危险因素

Analysis of risk factors for post-ERCP biliary infection

目的探讨梗阻性黄疸患者ERCP术后胆道感染的危险因素及治疗策略。方法回顾性分析我院普外科自2010年1月至2014年7月内因梗阻性黄疸在我院行ERCP治疗的149例患者临床资料,分析发生感染的相关因素,包括年龄,性别,疾病的良恶性质(胆管结石组与恶性梗阻性黄疸组),发生梗阻的部位(肝门部及以上部位组与胆总管下段组),ERCP操作的时间(>30 min组与≤30 min组),是否置入胆道支架,胆道支架的材质(塑料与金属支架)。对发生胆道感染的患者行血培养及药敏实验,指导临床用药。结果按是否发生胆道感染分为胆道感染组24例与非胆道感染组125例,单因素分析结果显示两组间疾病的良恶性质及梗阻的部位差异有统计学意义,而年龄、性别、ERCP操作时间、胆道支架的置入、支架的材质间无明显统计学差异。24例胆道感染组血培养阳性11例,药敏结果显示所有细菌对亚胺培南、头孢吡肟及头孢哌酮舒巴坦敏感率大于95%。结论疾病的良恶性质及胆道梗阻的部位是ERCP术后胆道感染的独立危险因素,对高危患者应采取相应措施预防胆道感染的发生。

Objective to investigate the incidence of post-ERCP biliary tract infection of patients with obstructive jaundice. Method To study retrospectively and recall the 149 clinical cases with obstructive jaundice which underwent ERCP from January 2010 to July 2014. Factors of patient-related included age, gender, nature （calculus of bile duct and malignant obstructive jaundice）, loca- tion of the obstruction （porta hepatis and distal common bile duct）, operation time, biliary stent placement, biliary stent materials. The blood specimens of case with biliary tract infection were collected for bacterial culture and drug sensitive test. Result All the cases were divided into biliary tract infection group（24 cases） and non-biliary tract infection group（ 125 cases）. In the univariate analysis, nature and obstruction of the parts were statistically significant; however age, gender, operation time, biliary stent placement and biliary stent materials were not statistically significant. Bactctia were found in 11 cases of 24 patients with biliary tract infection, and imi- penem, cefepime and cefoperazone were sensitively. Conclusion The nature of disease and obstruction of the parts were independent risk factor for post-ERCP cholangitis. We should take corresponding measures to prevent the incidence of biliary infections in high-risk patients.