经皮肝穿刺胆道支架置入术后发生胆系感染的危险因素分析

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

目的: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危险因素。方法:收集2006年1月至2014年12月128例因不能切除而在我院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24.2%(31/128)。胆管内生性狭窄患者中术后胆系感染发生率为32.4%,高于胆管外压性狭窄患者(13.0%)。胆管支架跨十二指肠乳头放置术后胆系感染发生率为31.0%,高于胆管支架未跨十二指肠乳头放置患者(22.4%)。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,对于胆管支架跨十二指肠乳头放置,胆管内生性肿瘤患者,术后发生胆系感染的可能性较高。

Objective：To evaluate predisposing factors for early infectious complications after percuta-neous metallic biliary stent insertion in patients with malignant biliary obstruction. Methods： From January 2006 to December 2014, 128 consecutively registered patients with inoperable 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 complica-tions were compared with those in patients without early infectious complications.Results：Infectious complica-tions occurred within 30 days after stent placement in 31 of 128 （24.2%） patients. The incidence of infectious complications in patients with endophytic type biliary stricture（32.4%） was higher than external pressure type （13.0%）. The incidence of infectious complications in patients with transpapillary stent placement （31.0%） was higher than nontranspapillary stent placement（22.4%）.Conclusion：There was a possibility of early bili-ary infectious after percutaneous placement of a metallic stent. Stent implantation across the main duodenal pa-pilla and biliary endophytic tumor seemed to have a higher incidence of biliary infectious.