ERCP术后胆道感染分析  

Analysis of biliary tract infection after ERCP surgery

作　　者：尹红[1] 罗保平[1] 李春亭[1] 

机构地区：[1]湖北省中医院普外科,武汉430061

出　　处：《西南国防医药》2016年第5期539-541,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨经内镜逆行胰胆管造影(ERCP)术后发生胆道感染的情况及处理对策,为临床预防ERCP术后感染提供参考。方法选取我院收治的243例采用ERCP治疗梗阻性黄疸的患者,按照胆道感染与否分为感染组和非感染组,回顾性分析发生术后感染的情况及影响因素。结果术后发生胆道感染37例,感染率为15.23%。其中男性20例,女性17例;年龄>60岁的15例,年龄≤60岁的22例;置入胆道支架患者19例,未置入胆道支架的18例;置入金属支架患者6例,塑料支架的13例,与非感染组比较,分布均无统计学差异(P>0.05)。原发病为恶性的感染患者30例,为良性的7例;高位梗阻感染患者30例,低位梗阻患者7例;ERCP操作时间<30 min的感染患者5例,≥30 min的感染患者32例,与非感染组比较,分布差异均具有统计学意义(P<0.05)。37例感染患者病原菌分布中,G-杆菌最常见(86.49%),其中大肠埃希菌12例,阴沟肠杆菌8例,肠炎克雷伯菌9例,铜绿假单胞菌3例;G+菌占8.11%,其中肠球菌属2例,链球菌属1例;白色链珠菌2例。结论 ERCP术后感染率为15.23%,主要由G-杆菌感染引起,感染因素主要为恶性疾病、高位梗阻和ERCP操作时间≥30 min。采用ERCP治疗梗阻性黄疸时,应采取针对性的预防,以减少术后胆道感染的发生。Objective To investigate the ocurrence of biliary tract infection after endoscopic retryrade cholangio pancreatograph（ERCP） and atrategies in order to provide clinical reference for the prevention of post-ERCP infection. Methods 243 cases of obstructive jaundice treated by ERCP were selected and divided into infection group and non-infection group according to the situation of biliary tract infection. A retrospective analysis was made in the postoperative infection and influencing factors. Results There were 37 cases of biliary tract infection after the operation. The infection rate was 15.23%, in which there were 20 males and 17 females. There were 15 cases with the age larger than 15 and 22 cases with the age ≤ 60. Biliary stent implantation was carried out in 19 cases, and 18 cases had no biliary stent implantation. Metal stents were implanted in 6 cases, and plastic stents were implanted in 13 cases. The difference was not significant（P 0.05）. There were 30 cases of infection in patients with benign disease, and 7cases were benign. There were 30 patients with high obstruction infection and 7 with lower obstruction. ERCP operation time was less than 30 min in 5 cases and ≥30 min in 32 cases, and the differences were significant（P 0.05）. Among the post-ERCP pathogen distribution in 37 infected patients, G-bacilli was the most common（86.49%）, of which 12 cases were E. coli; 8 were enterobacter cloacae; 9 were enteritis klebsiella; 3 were pseudomonas aeruginosa. G＋bacteria accounted for 8.11%, in which there were two cases of enterococcus, one of streptococcus; and two of white chain beads bacteria. Conclusion ERCP postoperative infection rate is15.23%. It is mainly caused by the G-bacillus infection. The main factors are malignant disease, the occurrence of superior position obstruction, and ERCP operation duration ≥30 min. ERCP for the treatment of obstructive jaundice should choose proper prevention measures in order to reduce the incidence of postoperative biliary tract infection.

关 键 词：ERCP 术后 胆道感染 影响因素 病原菌 

分 类 号：R619.3[医药卫生—外科学]