EST术后胆道感染的发生情况及危险因素分析  

Risk factors for post-endoscopic sphincterotomy biliary tract infection in patients with choledocholithiasis

作　　者：周乐宝 吴杰云 

机构地区：[1]湖北省咸宁市中心医院消化内科,湖北省咸宁市437100

出　　处：《世界华人消化杂志》2016年第26期3831-3836,共6页World Chinese Journal of Digestology

摘　　要：目的分析胆总管结石患者内镜乳头括约肌切开取石(endoscopic sphincterotomy,EST)术后胆道感染的危险因素.方法选取2012-05/2015-05我院收治的102例胆总管结石患者作为研究对象,所有患者均行EST手术,将患者是否发生术后胆道感染分为感染组及对照组,比较两组患者的术前资料、手术资料、基础疾病及既往史,并对胆道感染的危险因素进行Logistic多元回归分析.结果102例患者中29例(28.43%)出现术后胆道感染.结石直径超过25 mm(OR=1.971,95%CI:0.975-3.489)、胆管扩张/狭窄(OR=2.971,95%C I:1.165-4.724)、手术期间多次应用经内镜逆行性胰胆管造影术(endoscopic r e t r o g r a d e c h o l a n g i o-p a n c r e a t o g r a p h y,ERCP)(OR=2.217,95%CI:1.019-4.876)、碎石术应用(O R=2.5 9 8,9 5%C I:1.147-4.790)、手术时间≥60 m i n(O R=2.087,95%C I:1.994-3.867)、糖尿病(O R=2.176,95%CI:1.763-3.885)、胆道手术(OR=1.723,95%CI:1.357-3.109)、既往ERCP(OR=2.089,95%CI:1.665-3.576)及胆管支架(OR=2.219,95%C I:1.982-3.347)是胆道感染的危险因素,预防性使用抗生素是胆道感染的保护因素(OR=0.471,95%CI:0.231-0.796).结论E S T后患者胆道感染的发生与多种因素有关,预防性使用抗生素具有一定的保护作用.AIM To identify the risk factors for post-endoscopic sphincterotomy（EST） biliary tract infection in patients with choledocholithiasis. METHODS From May 2012 to May 2015, 102 patients with choledocholithiasis were chosen as study subjects, and all patients were treated by EST. These patients were divided into an infection group and a control group. Pre-operative data, operative data, basic diseases and history were compared between the two groups to identify the risk factors for biliary tract infection after EST. RESULTS A total of 29 patients were diagnosed with biliary tract infection. Diameter of stones ≥ 25 mm（OR = 1.971, 95%CI： 0.975-3.489）, biliary dilatation/stricture（OR = 2.971, 95%CI： 1.165-4.724）, multiple ERCP（OR = 2.217, 95%CI： 1.019-4.876）, lithotripsy（OR = 2.598, 95%CI： 1.147-4.790）, operative time ≥ 60 min（OR = 2.087, 95%CI： 1.994-3.867）, diabetes（OR = 2.176, 95%CI： 1.763-3.885）, biliary operation（OR = 1.723, 95%CI： 1.357-3.109）, ERCP history（OR = 2.089, 95%CI： 1.665-3.576） and biliary stent（OR = 2.219, 95%CI： 1.982-3.347） were risk factors for post-EST biliary tract infection. Usage of antibiotics was identified to be a protective factor for post-EST biliary tract infection（OR = 0.471, 95%CI： 0.231-0.796）. CONCLUSION Post-EST biliary tract infection demonstrates significant relativity with multiple factors, while usage of antibiotics exerts a protective effect against the infection.

关 键 词：胆总管结石 内镜乳头括约肌切开取石术 胆道感染 

分 类 号：R657.42[医药卫生—外科学]