胆道梗阻相关胆源性肝脓肿的手术方式及病原学特点

Etiology features and surgical methods of biliary liver abscesses related with biliary tract obstruction

目的探讨胆道梗阻相关胆源性肝脓肿外科手术方式,并总结其病原学特点。方法回顾性分析2017年1月至2020年1月河南省人民医院收治的胆道梗阻相关胆源性肝脓肿43例患者的临床资料,其中行单纯胆道手术解除梗阻8例,胆道手术联合肝脓肿切开引流13例,胆道手术联合肝部分切除22例。分析其手术情况及病原学特点。结果单纯胆道手术、胆道手术联合肝脓肿切开引流患者术前白细胞高于胆道手术联合肝部分切除者,差异有统计学意义(P<0.05)。所有患者均治愈出院,无死亡病例,三种处理方式患者手术时间、出血量、输血情况、术后第1天实验室指标比较,差异未见统计学意义(P>0.05),但单纯胆道手术患者术后住院时间长于另外两种处理方式,差异有统计学意义(P<0.05)。病原菌以大肠埃希菌为主,其中产超广谱β-内酰胺酶(ESBL)大肠埃希菌占72.73%(8/11)。结论去除原发病,解除胆道梗阻在外科手术治疗胆道梗阻相关胆源性肝脓肿中更为关键,术中联合肝脓肿切开引流有助于加速患者康复,缩短术后住院时间,多因素导致引流术后长期难以闭合、脓肿多分隔无法充分引流者则需考虑联合肝部分切除术。病原菌以大肠埃希菌为主,经验性选用抗生素时首先应考虑革兰阴性菌感染的可能,同时应警惕产ESBL菌的可能性。

Objective To investigate the surgical methods for biliary liver abscesses related with biliary tract obstruction,and summarize the characteristics of etiology.Methods The clinical data of 43 cases of biliary liver abscesses related with biliary tract obstruction in Henan Provincial People’s Hospital from January 2017 to January 2020 were analyzed retrospectively.Among them,8 cases underwent simple biliary tract surgery to remove obstruction,13 cases underwent biliary tract operation combined with liver abscess incision and drainage,and 22 cases underwent biliary tract operation combined with partial hepatectomy.The operation and etiological characteristics were analyzed.Results The leukocytes of patients undergoing biliary tract operation alone,biliary tract operation combined with liver abscess incision and drainage before operation were higher than those of patients with biliary tract operation combined with partial hepatectomy,the differences were significant(P<0.05).All the patients were cured and discharged without death.There were no significant differences in operation time,bleeding volume,blood transfusion status,and laboratory indexes on the first day after operation among the three treatment methods(P>0.05),but the postoperative hospitalization time in the simple biliary operation group was significantly longer than that by the other two treatment methods,and the difference was significant(P<0.05).Escherichia coli was the main pathogen,and 72.73%(8/11)of the produce extended spectrumβ-lactamases(ESBL).Conclusions It is more important to remove the primary disease and remove the biliary obstruction in the surgical treatment of biliary liver abscesses related with biliary tract obstruction.The combination of incision and drainage of liver abscesses during the operation is helpful to accelerate the recovery and shorten the postoperative hospital stay,multiple factors lead to long-term difficulty in closure after drainage,and the abscess is multi-septum which can not be fully drained,partial hepatectomy should be considered.Escherichia coli is the main pathogen of biliary liver abscess related with biliary obstruction.The possibility of Gram-negative bacteria infection should be considered first when antibiotics are selected empirically,and the possibility of producing ESBL should be warned at the same time.