肝门部胆管癌患者经内镜下射频消融和金属支架植入治疗后胆道感染病原菌与影响因素  

Pathogens isolated from hilar cholangiocarcinoma patients with biliary tract infection after radiofrequency ablation and metal stent implantation under endoscopy and influencing factors

作　　者：姜继华 姜仁鸦[2] 汪正飞[2] 徐华伟 郑树森[1] JIANG Ji-hua;JIANG Ren-ya;WANG Zheng-fei;XU Hua-wei;ZHENG Shu-sen(The First Afffiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310003,China)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,浙江杭州310003 [2]衢州市人民医院肝胆外科,浙江衢州324000

出　　处：《中华医院感染学杂志》2020年第18期2794-2798,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81721091);衢州市科技计划指导性基金资助项目(20172019)。

摘　　要：目的研究肝门部胆管癌(Hilar cholangioc arcinoma,HCCA)患者经内镜逆行胰胆管造影(Endoscopic retrogarde cholagiopanceratography,ERCP)下射频消融(Radiofrequency ablation,RFA)和金属支架植入治疗后胆道感染的病原菌与影响因素。方法选取2016年10月-2019年10月浙江大学医学院附属第一医院和浙江省衢州市人民医院206例HCCA患者为样本进行前瞻性研究,均在完善检查后行ERCP射频消融和金属支架置入治疗,随访术后3个月内胆道感染发生情况,分析病原菌分布情况及感染的影响因素。结果206患者术后发生胆道感染43例(20.87%),胆汁培养共检出病原菌52株,其中革兰阳性菌16株占30.76%,革兰阴性菌31株占59.62%,真菌5株占9.62%;另外血培养共检出病原菌27株,革兰阳性菌和革兰阴性菌分别为7株占25.93%和20株占74.07%,与胆汁培养结果一致率分别为43.75%(7/16)和64.52%(20/31);年龄>65岁、Child-Pug分级C级以及金属支架长度80 mm是HCCA患者支架植入治疗后胆道感染的影响因素(P<0.05),RFA治疗2次和覆膜支架为保护因素(P<0.05)。结论RFA和支架植入治疗HCCA后胆道感染发生风险较高,其中病原菌主要为革兰阴性菌,年龄>65岁、Child-Pug分级C级和金属支架长度80 mm为影响因素,覆膜支架或联合应用RFA均有利于减少感染发生。OBJECTIVE To investigate the pathogens causing biliary tract infection in hilar cholangiocarcinoma(HCCA)patients after radiofrequency ablation(RFA)under endoscopic retrograde cholangiopancreatography(ERCP)and metal stent implantation and analyze the influencing factors.METHODS A prospective study was conducted for 206 patients who were treated in the First Affiliated Hospital,College of Medicine,Zhejiang University and People′s Hospital of Quzhou from Oct 2016 to Oct 2019,all of the patients underwent ERCP RFA and metal stent implantation after thorough examination,a follow-up was conducted for the incidence of biliary tract infection within 3 months after the surgeries,and the distribution of pathogens and influencing factors for the infection were observed.RESULTS Of the 206 patients,43(20.87%)had postoperative biliary tract infection;totally 52 strains of pathogens were isolated from bile specimens,16(30.76%)of which were gram-positive bacteria,31(59.62%)were gram-negative bacteria,and 5(9.62%)were fungi;totally 27 strains of pathogens were isolated from blood specimens,7(25.93%)of which were gram-positive bacteria,and 20(74.07%)were gram-negative bacteria;the consistency rates with the results of bile culture were 43.75%(7/16)and 64.52%(20/31),respectively.More than 65 years of age,Child-Pug grade C and 80 mm length of metal stent were the influencing factors for the biliary tract infection in the HCCA patients after the stent implantation(P<0.05);RFA for twice and covered stent were the protective factors(P<0.05).CONCLUSION The patients are at high risk of biliary tract infection after RFA and stent implantation of HCCA.The gram-negative bacteria are dominant among the pathogens.More than 65 years of age,Child-Pug grade C and 80 mm length of metal stent are the influencing factors.The covered stent or combined application of RFA is beneficial to reduce the incidence of infection.

关 键 词：肝门部胆管癌 射频消融 支架植入 胆道感染 病原菌 影响因素 

分 类 号：R735.8[医药卫生—肿瘤]