不同术前胆道引流方式对恶性梗阻性黄疸胆汁细菌培养及耐药性的影响  

Effects of different preoperative biliary drainage methods on bile bacterial culture and drug resistence of malignant obstructive jaundice

作　　者：潘孜博 王宇宏[2] 孔哲[3] 刘哲[3] 王敬[3] Pan Zibo;Wang Yuhong;Kong Zhe;Liu Zhe;Wang Jing(Medical School of Chinese PLA,Beijing 100853,China;Department of Emergency,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Department of Hepatobiliary Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第四医学中心急诊科,北京100048 [3]解放军总医院第一医学中心肝胆外科,北京100853

出　　处：《中华消化外科杂志》2021年第11期1191-1200,共10页Chinese Journal of Digestive Surgery

基　　金：海南省卫生计生行业科研项目(15A200088)。

摘　　要：目的探讨不同术前胆道引流方式对恶性梗阻性黄疸胆汁细菌培养及耐药性的影响。方法采用回顾性描述性研究方法。收集2015年1月至2018年12月解放军总医院第一医学中心收治的317例恶性梗阻性黄疸病人的临床资料;男216例,女101例;年龄为(62±10)岁。317例病人中,158例术前无胆道引流,115例术前胆道引流方式为经皮经肝穿刺胆道引流(PTCD),44例术前胆道引流方式为经内镜逆行胆道引流(ERBD)。观察指标:(1)不同术前胆道引流方式胆汁细菌培养情况。(2)胆汁细菌培养阳性病人临床病理特征。(3)不同术前胆道引流方式胆汁细菌耐药性情况。正态分布的计量资料以x±s表示,计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验,两两比较进行Bonferroni校正,多重比较中检验水准为0.0167。结果(1)不同术前胆道引流方式胆汁细菌培养情况:317例病人中,116例细菌培养阳性,包括43个菌种共168株菌株,其中术前无胆道引流36例(46株),行PTCD 39例(49株),行ERBD 41例(73株)。①317例病人细菌培养阳性率为36.59%(116/317),术前无胆道引流、行PTCD、行ERBD病人细菌培养阳性率分别为22.78%(36/158)、33.91%(39/115)、93.18%(41/44),3者细菌培养阳性率比较,差异有统计学意义(χ^(2)=74.066,P<0.05),其中术前行PTCD与术前无胆道引流病人比较,差异无统计学意义(χ^(2)=4.137,P>0.0167),术前行ERBD与术前无胆道引流和行PTCD病人比较,差异均有统计学意义(χ^(2)=72.305,44.718,P<0.0167)。②多重细菌感染占比为36.21%(42/116),术前无胆道引流、行PTCD、行ERBD病人多重细菌感染占比分别为19.44%(7/36)、23.08%(9/39)、63.41%(26/41),3者多重细菌感染占比比较,差异有统计学意义(χ^(2)=20.431,P<0.05),其中术前行PTCD与术前无胆道引流病人比较,差异无统计学意义(χ^(2)=0.147,P>0.0167),术前行ERBD与术前无胆道引流和行PTCD病人比较,差异均有统计学意义(χ^(2)=15.133,13Objective To investigate the effects of different preoperative biliary drainage methods on bile bacterial culture and drug resistence of malignant obstructive jaundice.Methods The retrospective and descriptive study was conducted.The clinical data of 317 patients with malignant obstructive jaundice who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2018 were collected.There were 216 males and 101 females,aged(62±10)years.Of 317 patients,158 cases had no preoperative biliary drainage,115 received preoperative biliary drainage by percutaneous transhepatic choledochal drainage(PTCD),44 received preoperative biliary drainage by endoscopic retrograde biliary drainage(ERBD).Observation indicators:(1)bile bacteria in different preoperative biliary drainage methods;(2)clinicopathological characteristics of patients with positive bile bacteria;(3)drug resistance of bile bacteria in different methods of preoperative biliary drainage.Measurement data with normal distribution were expressed as Mean±SD.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed by the chi-square test.Bonferroni correction was used for pairwise comparison.The inspection level was 0.0167 in the multiple comparison.Results(1)Bile bacteria in different preoperative biliary drainage methods:of 317 patients,116 cases were positive for bacterial culture,including 168 strains of 43 bacterial types.There were 46 strains from 36 patients without preoperative biliary drainage,49 strains from 39 patients with preoperative PTCD and 73 strains from 41 patients with preoperative ERBD.①The positive rate of bacteria for 317 patients was 36.59%(116/317).The positive rates of bacteria for patients without preoperative biliary drainage,patients with preoperative PTCD and patients with preoperative ERBD were 22.78%(36/158),33.91%(39/115)and 93.18%(41/44).There was a significant difference in the positive rate of bacteria among the three groups(χ2=74.066,P<0.0

关 键 词：黄疸 恶性梗阻性 细菌 抗菌药物 经皮肝穿胆道引流术 内镜逆行胆道引流术 

分 类 号：R730.5[医药卫生—肿瘤] R446.5[医药卫生—临床医学]