内镜下乳头切开加球囊扩张术后胆道感染危险因素与预防措施  

Risk factors for postoperative biliary tract infections in patients undergoing endoscopic papilla sphincterotomy plus balloon dilatation and prevention measures

作　　者：董金良 梁金荣 张玉惠 

机构地区：[1]舟山医院肝胆外科,浙江舟山316000 [2]舟山医院普外科,浙江舟山316000

出　　处：《中华医院感染学杂志》2015年第9期2083-2085,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(2013KYB204)

摘　　要：目的研究内镜下逆行胰胆管造影(ERCP)乳头切开加球囊扩张,治疗肝胆胰疾病后胆道感染的危险因素及其预防措施,为临床上治疗肝胆胰疾病及防治术后并发症提供参考。方法将1 500例肝胆胰疾病患者实施ERCP行乳头切开加球囊扩张术,对其中发生术后胆道感染的患者,根据就诊前和术后资料采用单因素和多因素分析方法分析发生胆道感染的危险因素,并根制定预防措施。结果 155例患者发生术后胆道感染,感染率为10.3%;肝功能分级、术前合并胆道感染、术中反复插管、注入造影剂过量、胆道狭窄、原发性硬化胆管炎、肝移植术后、十二指肠乳头旁憩室、预防性使用抗菌药物、术后患者自身免疫功能低下是ERCP乳头切开加球囊扩张治疗肝胆胰疾病后胆道感染的危险因素(P<0.05);进一步行多因素logistic回归分析结果显示,原发性硬化胆管炎(OR=4.089)、术前合并胆道感染(OR=2.884)、胆道狭窄(OR=2.718)是术后并发胆道感染的前3位主要危险因素,而术前预防性使用抗菌药物(OR=0.042)则可以降低术后并发胆道感染的概率。结论使用ERCP乳头切开加球囊扩张术可引发胆道感染,了解胆道感染发生的危险因素,根据患者术前情况,预防使用抗菌药物、合理使用造影剂的用量等可以有效预防术后胆道感染的发生。OBJECTIVE To explore the risk factors for the postoperative biliary tract infections in the patients un‐dergoing endoscopic retrograde cholangiopancreatography （ERCP） incision plus balloon dilation and put forward the prevention measures so as to provide guidance for the clinical treatment of hepatobiliary and pancreatic diseases and the prevention of postoperative complications .METHODS A total of 1 500 patients with hepatobiliary and pan‐creatic diseases who underwent papilla sphincterotomy plus balloon dilatation through ERCP were enrolled in the study .The univariate analysis and multivariate analysis were performed based on the preoperative and postopera‐tive data so as to analyze the risk factors for the biliary tract infections and put forward the prevention measures . RESULTS The postoperative biliary tract infections occurred in 155 patients ,with the infection rate of 10 .3% .The risk factors for the postoperative biliary tract infections in the patients with hepatobiliary and pancreatic diseases undergoing ERCP incision plus balloon dilatation included the liver function classification ,preoperative complica‐tion of biliary tract infections ,intraoperative repeated intubation ,excessive use of contrast agent ,biliary tract ste‐nosis ,primary sclerosing cholangitis ,liver transplantation ,juxtapapillary duodenal diverticula ,prophylactic use of antibitoics ,and low autoimmune function （P〈0 .05） .The multivariate logistic regression analysis further revealed that the primary sclerosing cholangitis （OR=4 .089） ,preoperative complication of biliary tract infections （OR=2 .884） ,and biliary tract stenosis （OR=2 .718） ranked the top three risk factors for the postoperative complica‐tion of biliary tract infections ,while the preoperative antibiotics prophylaxis （OR=0 .042） could reduce the inci‐dence of the postoperative biliary tract infections .CONCLUSION The ERCP papilla sphincterotomy plus balloon dilatation may induce the biliary tract infections .It is an effecti

关 键 词：内镜下逆行胰胆管造影 球囊扩张 胆道感染 

分 类 号：R575.6[医药卫生—消化系统]