[1]于平,戴定可,钱晓军,等.胆管引流或支架置入术后感染的临床分析与处理[J].介入放射学杂志,2007,(10):693.
　YU Ping,DAI Ding-ke,QIAN Xiao-jun,et al.Clinical analysis and management of infections relative to percutaneous biliary drainage or stenting dilation[J].journal interventional radiology,2007,(10):693.
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胆管引流或支架置入术后感染的临床分析与处理()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2007年10期
页码:
693
栏目:
临床研究
出版日期:
2007-10-15

文章信息/Info

Title:
Clinical analysis and management of infections relative to percutaneous biliary drainage or stenting dilation
作者:
于平; 戴定可; 钱晓军; 等
１０００２０北京首都医科大学附属朝阳医院放射科
Author(s):
YU Ping; DAI Ding-ke; QIAN Xiao-jun; ZHAI Ren-you．
Department of Radiology，Beijing Chaoyang Hospital，Capital Medical University，Beijing１０００２０，China
关键词:
恶性肿瘤／梗阻性黄疸; 介入放射学; 并发症
分类号:
R７３５.８
文献标志码:
B
摘要:
目的分析胆管引流术或支架置入治疗恶性梗阻性黄疸相关胆管感染及其防治。方法恶性梗阻性黄疸１８１例，其中肝胆管癌８１例，胰腺壶腹肿瘤４２例，胃肠肿瘤肝门淋巴结转移瘤５８例。全部病例根据病情分别给以保肝、支持、抗炎治疗，并根据胆管梗阻情况分别施行胆管引流术或胆管支架置入术。记录、分析围手术期相关感染的发生及治疗。结果全部病例行经皮经肝穿刺胆管引流术或胆管支架置入术。围手术期并发症以胆道感染为主。术前合并胆系感染者６２例（３４．３％），术后感染控制５０例，未能控制１２例。术后新发胆系感染１８例（１５．１％），感染控制１３例，未能控制５例，合并肺部感染４例，因重度感染导致死亡１７例（９．４％）。胆汁培养显示革兰阴性肠杆菌及其内毒素血症是导致重度胆道感染的主要原因。术后合并急性胰腺炎者６５例（３５．９％），主要为轻型，无重症坏死型胰腺炎发生，及时抗胰腺炎治疗，均预后良好。胆漏肝内胆汁性脓肿１例（０．５５％），经穿刺引流脓肿冲洗抗感染治疗治愈。结论胆系感染是胆管梗阻最常见、最严重的并发症，也是经皮肝穿胆汁引流围手术期导致死亡的主要原因，及时有效的控制感染是降低病死率延长生存期的关键。急性胰腺炎的发生率较高，应高度重视，及时积极治疗，预后良好。

参考文献/References:

［１］Zhai RY，Qian XJ，Dai DK．Malignant biliary obstruction押treat-ment with interventional radiology［J］．J Chin Medi J，２００３，１１６：８８８-８９２．
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［５］Carrasco C，Zomoza J，Bechtel WJ．Malignant biliary obstruc-tion押complication of percutaneous biliary drainage［J］．Radiology，１９８４，１５２押３４３-３４６．
［６］R觟sch T，Triptrap A，Born P，et al．Bacteriobilia in percut-aneous transhepatic biliary drainage押occurrence over time and clinical sequelae．A prospective observational study［J］．Scand J Gastroentereol，２００３，３８：１１６２-１１６８．
［７］Baez-Villasenor，H觟ffken G，陈宜君．抗生素治疗新进展［N］．中国医学论坛报，２００６，３押１６-１７．
［８］陈民均，王辉．中国重症监护病房革兰阴性菌耐药性连续７年监测研究［J］．中华医学杂志，２００３，８５：３７５-３８１．
［９］罗燕萍，张秀菊，徐雅萍．产超广谱β内酰胺酶肺炎克雷伯菌和大肠埃希菌的分布及其耐药性研究［J］．中华医院感染学杂志，２００６，１６：１０１-１０４．
［１０］万建华，赵金满．胆系感染病原菌及耐药性分析［J］．世界华人消化杂志，２００４熏１２：１２３４-１２３５．

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备注/Memo

备注/Memo:
收稿日期：２００７-０３-０６
基金项目：国家十一五课题资助项目（２００７BAI０５B０６）
更新日期/Last Update: 2007-10-15