^(125)I放射性粒子条联合胆道支架与单纯胆道支架植入治疗恶性胆道梗阻的术后院内感染发生率及临床疗效的对照研究  

Comparative study on nosocomial infection rate and clinical efficacy between biliary stent loaded with radioactive^(125)I seeds strip and conventional biliary stent in the treatment of malignant biliary obstruction

作　　者：陈丽[1,2] 陈敏江 任建敏[3] 谢艳茹 涂建飞[1,2] 纪建松 Li Chen;Minjiang Chen;Jianmin Ren;Yanru Xie;Jianfei Tu;Jiansong Ji(Cancer Center,the Fifth Affiliated Hospital of Wenzhou Medical University(Lishui Municipal Central Hospital);Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research;Department of Laboratory Medicine,the Fifth Affiliated Hospital of Wenzhou Medical University(Lishui Municipal Central Hospital),Zhejiang Lishui 323000,China)

机构地区：[1]温州医科大学附属第五医院(丽水市中心医院)肿瘤中心,浙江丽水323000 [2]浙江省影像诊断与介入微创研究重点实验室 [3]温州医科大学附属第五医院(丽水市中心医院)检验科

出　　处：《中华介入放射学电子杂志》2024年第2期144-149,共6页Chinese Journal of Interventional Radiology：electronic edition

基　　金：浙江省医药卫生科技项目(2020KY1087);丽水市科技计划项目(2022GYX26)。

摘　　要：目的回顾性研究联合组[^(125)I(iodine)粒子条+胆道支架]及常规组(单纯胆道支架组)治疗恶性胆道梗阻(malignant biliary obstruction,MBO)的术后院内感染发生率及临床疗效。方法收集2019年4月至2022年6月期间因MBO就诊于温州医科大学附属第五医院(丽水市中心医院)且经皮肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)序贯行胆道支架植入的128例(联合组70例、常规组58例)MBO患者的临床资料,所有病例PTCD术中获取胆汁,术后监测相关指标及不良事件情况,分析2组的术后院内感染发生率、术后总胆红素下降速率、支架通畅时间、不良事件发生率等。结果2组术后院内感染发生率比较,差异无统计学意义(8.5%∶8.6%;P>0.05);WBC(blood cell count)计数>10×10^(9)/L者较WBC计数≤10×10^(9)/L者,PTCD术中胆汁阳性率相对更高(48%∶26.2%;P<0.05);本研究共39例患者胆汁培养阳性,病原体构成比居前3位分别为肺炎克雷伯菌13例(32%)、大肠杆菌9例(22%)、铜绿假单胞菌7例(18%)。联合组术后总胆红素下降速率相对更快(7.1 d∶11.2 d;P<0.05);联合组及常规组的胆道支架中位通畅时间分别为5.9个月(95%CI:5~7个月)、2.6个月(95%CI:2~4个月),差异有统计学意义(P<0.05)。结论联合组未增加术后院内感染发生率,且临床疗效优于常规组,安全性高;PTCD术前WBC计数>10×109/L者胆汁阳性率更高,该类患者建议及早使用抗生素;胆道常见病原体前3位分别为肺炎克雷伯菌、大肠杆菌、铜绿假单胞菌。Objective To compare the nosocomial infection rates and clinical efficacy between biliary stent loaded with radioactive^(125)I seeds strip(combined group)and conventional biliary stent(conventional group)in the treatment of malignant biliary obstruction.Methods Clinical data of128 patients(70 in the combined group and 58 in the conventional group)admitted to Lishui Municipal Central Hospital due to MBO who underwent percutaneous transhepatic cholangial drainage(PTCD)with sequential biliary stent implantation from April 2019 to June 2022 were retrospectively collected.Bile specimens were collected from all patients during PTCD,and relevant indicators and adverse events were monitored postoperatively.The incidence of nosocomial infection,rate of postoperative total bilirubin decline,stent patency time,and incidence of adverse events were analyzed for both groups.Results There was no statistically significant difference observed in the Nosocomial Infection Rate between the two groups(8.5%vs 8.6%;P>0.05).Notably,patients with a white blood cell count(WBC)exceeding 10×10^(9)/L exhibited a significantly higher rate of positive bile culture during PTCD in comparison to those with a WBC count of≤10×10^(9)/L(48%vs 26.2%;P<0.05).Among the 128 patients,a total of 39(39/128)displayed positive results in bile culture.The top three pathogens identified were Klebsiella pneumoniae(n=13;32%),Escherichia coli(n=9;22%),Pseudomonas aeruginosa(n=7;18%).Furthermore,the combined group demonstrated a notably more rapid decrease in total bilirubin levels compared to the conventional group(7.1 days vs 11.2 days;P<0.05).The median duration of biliary stent patency in the combined group was 5.9 months(95%CI:5-7 months),while in the conventional group,it was 2.6 months(95%CI:2~4 months).The difference in stent patency duration between the two groups was statistically significant(P<0.05).Conclusion The combined group exhibited no increase in the Nosocomial Infection Rate.Moreover,it demonstrated superior clinical efficacy with a high leve

关 键 词：院内感染 胆道感染 胆道梗阻 胆道支架 

分 类 号：R657.4[医药卫生—外科学]