经皮肝胆道支架置入术后胆系感染的相关因素研究

Study on the Relative Factors of Biliary Infectious after Percutaneous Stent Placement

探讨胆管恶性梗阻患者经皮肝穿刺胆道支架置入术后发生早期胆系感染的相关因素。方法:收集2004年1月至2014年12月253例行经皮肝穿刺胆管支架置入术治疗的恶性胆道梗阻患者。随访记录支架置入术后30d内患者是否发生胆系感染,以此计算胆管支架置入术后胆系感染率。并记录患者性别、年龄、胆管梗阻原因(内生或外压)、支架放置位置(是否跨十二指肠乳头)等临床特点,并通过比较这些临床特点以确定其是否为早期胆系感染的危险因素。结果:经皮肝穿刺胆管支架置入术后30d内胆系感染率为20.6%(52/253)。胆管内生性狭窄、胆管支架跨十二指肠乳头放置、术后结合胆红素下降不明显的患者术后均有较高的胆系感染率(P<0.05)。经Logistic回归分析,胆管支架放置位置及术后胆红素下降水平是术后发生胆系感染的独立危险因素。结论:经皮肝穿刺胆管支架置入术后有一定的胆系感染可能,胆管支架跨十二指肠乳头放置,术后结合胆红素水平下降不明显,是术后发生胆系感染的危险因素。

Objective： To evaluate predisposing factors for early infectious complications after percutaneous metallic biliary stent insertion in patients with malignant biliary obstruction. Methods： From January2004 to December 2014,253 consecutively registered patients with malignant biliary obstruction were treated with percutaneous placement of a metallic stent in our hospital. Biliary infections within 30 days after stent implantation were recorded。The incidence of early infectious complications was evaluated. Sex,age,type of obstruction（ endophytic type or external pressure type）,and stent position（ across or above the main duodenal papilla） were retrospectively reviewed. The findings in patients with early infectious complications were compared with those in patients without early infectious complications. Results： Infectious complications occurred within 30 days after stent placement in 52 of 253（ 20.6%） patients. The biliary infection rate in patients with endophytic type biliary stricture,transpapillary stent placement,unsignificant fall of conjugated bilirubin was higher（ P 〈0.05）. By Logistic regression analysis,biliary stent placement and level of postoperative bilirubin decreased are independent risk factors of postoperative infection of biliary tract. Conclusion： There was a possibility of early biliary infectious after percutaneous placement of a metallic stent. Stent implantation across the main duodenal papilla and postoperative level of conjugated bilirubin seemed to be the risk factors of biliary infectious.