【摘要】 目的探讨恶性梗阻性黄疸PTCD术后胆道感染情况及危险因素.方法回顾性分析2008年1月至2011年12月行PTCD术的恶性梗阻性黄疸病例共113例,统计胆道感的发生情况及致病菌分布.结合患者临床资料,筛选发生胆道感染的危险因素.结果 113例患者中25例发生感染,52例胆汁培养中培养出细菌,其中G-菌86%,G+菌14%,多为肠道菌群.单因素及多因素Logistic回归显示术前Child-Pugh分级,胆道外引流留置时间延长、高位胆道梗阻、出现胆道再狭窄为出现胆道感染的危险因素.结论胆道细菌感染为PTCD术后常见并发症,病原菌多为肠道内菌群,胆道感染多为内源性感染.术前肝功,术后是否存在胆道引流不畅,术后是否存在十二指肠液反流及其时间相关.提示减少术前准备时间,减少胆汁异常引流及保持胆道引流通畅,可减少PTCD术后感染风险.更多还原

【Abstract】 Objective To explore the incidence and risk factor of bacterial infection after Percutaneous Transhepatic Cholangio-Drainage,(PTCD) of Malignant Biliary Obstruction.Methods The clinical data of 113 cases after PTCD of Malignant Biliary Obstruction between 2008 and 2011 were collected and analyzed retrospectively.Results 113 patients underwent PTCD.Cholangitis was confirmed in 25 patients.The bile cultures were positive in 52 samples.Among them,the Gram-negative bacilli were 86%,where Gram-positive bacilli were 14%.Most of them were intestinal flora.The risk factors of Bacterial Infection after PTCD for Malignant Biliary Obstruction included the preoperative Child-Pugh score,prolonged biliary drainage catheters indwelling,high level biliary obstruction and restenosis of biliary duct.Conclusions Cholangitis is a common complication of PTCD.The primary cause of Cholangitis is the reflux of intestinal flora.The results suggest that shortenubg the time of preoperative preparation,reducing the reflux of duodenal juice and maintaining the biliary drainage unobstructed would reduce the risk of Cholangitis.更多还原