经内镜逆行胆管造影术后胆道感染情况及置入鼻胆管引流的治疗作用研究

The therapeutic value of endoscopic nasobiliary drainage for the infection of biliary tract associated with endoscopic retrograde cholangiography

目的探讨经内镜逆行胆管造影术（ERC）术后胆道感染的危险因素，以及经内镜鼻胆管引流术（ENBD）防治ERC后胆道感染的作用。方法按照严格的背景均衡性准入标准，将云南省第一人民医院2010年1月至2016年6月接受ERC的512例患者完全随机设计分为A、B组，A组ERC后行ENBD，B组ERC后未行ENBD。比较2组在不同病因及不同病变部位情况下术后胆道感染发生率。结果入组的512例患者中A组276例、B组236例，总体术后胆道感染率为4．30％（22／512）。A组术后胆道感染发生率较B组低[1．09％（3／276）比8．05％（19／236），χ^2=15．00，P=0．000]。病因中恶性胆道梗阻术后感染率最高（13．46％，14／104），病变部位以肝门部病变术后胆道感染发生率最高（13．43％，9／67）。结论ERC后行ENBD，确保胆汁引流通畅，能有效防止胆道感染的发生，对于恶性梗阻和肝门部病变患者尤其重要。

Objective To explore major risk factors for postoperative biliary tract infection associated with endoscopic retrograde cholangiography （ERC）, and to evaluate endoscopic nasobiliary drainage （ENBD） for intervening the infection. Methods A total of 512 patients who underwent ERC at the First People＇s Hospital of Yunnan Province from January 2010 to June 2016 were enrolled and divided into group A and B randomly. Group A underwent ENBD after ERC while group B without. The incidence rates of biliary tract infection in different causes and lesions were compared between the two groups. Results Among the 512 patients, there were 276 cases in group A and 236 cases in group B. The overall postoperative biliary infection rate was 4. 30% （22/512）. Patients in group A showed a smaller chance of developing postoperative biliary tract infection than that in group B [ 1.09% （3/276） VS 8. 05% （ 19/236）, χ^2 = 15.00, P= 0. 000]. Malignant biliary obstruction was the most common cause （ 13.46%, 14/104） and the most common site was hepatic portal （ 13.43%, 9/67）. Conclusion ENBD can ensure smooth drainage of bile duct therefore effectively prevent biliary tract infection after ERC, especially for patients with malignant biliary obstruction and hepatic portal lesion.