胆胰恶性肿瘤ERCP支架植入术后胆道感染的防治策略

Prevention and treatment of biliary tract infection after ERCP stent implantation in biliary and pancreatic cancer

目的探讨经内镜逆行胰胆管造影(ERCP)支架植入治疗胆胰恶性肿瘤术后发生胆道感染的原因及防治策略,为临床预防ERCP支架植入术后胆道感染提供参考。方法回顾性分析2015年6月至2017年6月胆胰恶性肿瘤经ERCP行胆管支架植入引流治疗41例患者的临床资料。观察术后肝功能恢复情况及胆道感染情况。结果经ERCP行胆管支架植入引流患者共41例,支架植入失败2例,成功39例,成功率为95.1%(39/41)。与术前比较,胆管支架植入术后1周复查TBIL、DBIL、ATL、AST、GGT和ALP水平均显著下降,差异有统计学意义(P均<0.01)。术后随访24个月内发现合并术后胆道感染9例,发生率为23.1%(9/39),其中急性胆囊炎4例,急性胆管炎3例,肝脓肿2例。分别采取抗感染、经皮肝穿刺胆管引流术、经皮胆囊穿刺置管引流、取石球囊清理胆泥及更换支架等处理,9例患者均治愈,未出现严重并发症。结论 ERCP支架植入术后胆道感染形成的原因有多种,应采取针对性的预防措施给予处理,针对不同原因采取相应的治疗方法可降低术后胆道感染的发生。

Objective To investigate the causes of biliary infection after stent implantation by endoscopic retrograde cholangiopancreatography（ ERCP） and the prevention and treatment strategies for patients with biliary pancreatic malignant tumor to provide references for clinical prevention of biliary infection after ERCP stent implantation（ SI）. Methods The clinical data of 41 patients with biliary pancreatic cancer,in whom ERCP biliary stent implantation and drainage was performed from June 2015 to June 2017 was retrospectively analyzed. Postoperative liver function recovery and biliary tract infection were observed. Results Out of 41 patients who underwent ERCP for biliary SI,successful rate of SI was accounted for 95. 1%（ 39/41） with failure SI in 2 cases. Compared with preoperation,the levels of TBIL、DBIL、ALT、AST、GGT and ALP declined significantly at 1 week after biliary SI（ all P〈0. 01）. During 24 months of follow-up,there were 9 cases（ 23. 1%） of biliary tract infection,including 4 cases of acute cholecystitis,3 cases of acute cholangitis and 2 cases of liver abscess,who were cured by anti-infection,percutaneous transhepatic choledochic drainage（ PTCD）,percutaneous cholecystepacentesis and drainage,stone balloon cleaning and replacement of stents,respectinely. No serious complication occurred. Conclusion There are many reasons for the biliary tract infection after ERCP stent implantation,and corresponding prevention measures can reduce the incidence of postoperative biliary tract infection.