恶性梗阻性黄疸患者经皮穿刺肝胆管引流术后胆管感染的临床分析及预防研究

Clinical Analysis and Prevention of Biliary Tract Infection after Percutaneous Transhepatic Cholangial Drainage in Patients with Malignant Obstructive Jaundice

目的分析恶性梗阻性黄疸患者经皮穿刺肝胆管引流（PTCD）术后胆管感染的危险因素,并探讨预防措施。方法选择2011年1月至2013年1月在大连市友谊医院接受诊治的恶性梗阻性黄疸患者75例,分析行PTCD术后胆管感染病原菌的分布及构成情况,并对其危险因素进行筛选分析。结果本组75例患者中,19例患者发生胆管感染,感染率为25.3%。采集标本并培养159株,阳性标本为81株,其中革兰阳性菌12株,占14.8%;革兰阴性菌69株,占85.2%。革兰阳性菌主要以粪肠球菌（8.6%）及鸟肠球菌（4.9%）为主;革兰阴性菌以大肠埃希菌（48.1%）及克雷伯菌（24.7%）为主。多因素Logistic回归分析结果显示,梗阻位置时间（OR=14.261,95%CI 5.281-31.862）、出现胆管再狭窄（OR=3.862,95%CI 5.281-31.862）、外引流管留置时间（OR=9.137,95%CI 1.469-15.957）是PTCD术后胆管感染的危险因素（P〈0.05）。结论 PTCD术后胆管细菌感染为其常见并发症,梗阻位置、胆管再狭窄及外引流管留置时间为PTCD术后胆管感染的危险因素,采取有效预防措施可降低PTCD术后胆管感染的发生。

Objective To analyze the risk factors of biliary tract infection after percutaneous transhepatic cholangial drainage（PTCD） in patients with malignant obstructive jaundice.Methods A total of 75 patients with malignant obstructive jaundice admitted in Dalian Friendship Hospital from Jan.2011 to Jan.2013 were selected,distribution and composition of pathogens of postoperative biliary tract infection after PTCD and risk factors of the infection were analyzed.Results Among 75 patients, biliary tract infections occurred in 19 patients,the infection rate was 25.3%.Specimens were collected and 159 strains of pathogens were cultured, including 81 strains of positive samples,among which there were 12 stains of gram -positive bacteria,account-ing for 14.8%;69 strains of gram-negative bacteria,accounting for 85.2%.Gram-positive bacteria mainly in-cluded Enterococcus faecalis（8.6%） and birds enterococci（4.9%）;while gram-negative bacteria mainly included Escherichia coli（48.1%） and Klebsiella（24.7%）.Results of multivariate logistic analysis showed that site of obstruction（OR =14.261,95%CI 5.281-31.862）,bile duct restenosis（OR =3.862,95%CI 5.281-31.862）,inwelling of external drainage catheter （OR=9.137,95%CI 1.469-15.957） were the risk factors of biliary tract infection after PTCD（P 〈0.05）.Conclusion Biliary tract infection after PTCD is common complication of obstruction,site of obstruction,bile duct restenosis and indwelling time of external drainage catheter are independent risk factors for the infection ,effective preventive measures can reduce the incidence of biliary tract infection after PTCD .