| 唐启耀.胆道感染在恶性梗阻性黄疸PTCD术后患者中的发生情况及其风险因素调查研究[J].安徽医药,待发表. |
| 胆道感染在恶性梗阻性黄疸PTCD术后患者中的发生情况及其风险因素调查研究 |
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| 投稿时间：2026-08-25 录用日期：2026-10-16 |
| DOI： |
| 中文关键词: 胆道感染 恶性梗阻性黄疸 经皮肝穿刺胆道引流 风险因素 |
| 英文关键词: |
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| 中文摘要: |
| 目的 探讨胆道感染在恶性梗阻性黄疸（MOJ）经皮肝穿刺胆道引流（PTCD）术后患者中的发生情况，并分析其病原菌分布及风险因素。方法 回顾性分析2022年1月—2026年1月于信阳市中心医院行PTCD术的395例MOJ患者的临床资料，根据术后是否发生胆道感染分为感染组（51例）和对照组（344例）。收集患者一般资料、基础疾病情况、手术操作因素、术后管理因素、肿瘤相关因素及术前实验室指标，分析胆道感染发生情况及其病原菌分布，分析MOJ患者PTCD术后胆道感染的独立危险因素。结果 395例MOJ患者PTCD术后胆道感染发生率为12.91%。51例胆道感染患者检出病原菌55株，其中革兰阴性菌检出最多【41株（74.55%），以大肠埃希菌（38.18%）和铜绿假单胞菌（23.64%）为主】。感染组年龄≥75岁、术前黄疸天数≥21 d、胆道支架置入、术后胆汁引流不通畅及完全性胆道梗阻比例高于对照组（P<0.05）。年龄≥75岁（OR=1.322，95%CI：1.053~1.659）、术前黄疸天数≥21 d（OR=1.368，95%CI：1.056~1.771）、胆道支架置入（OR=1.354，95%CI：1.083~1.693）、术后胆汁引流不通畅（OR=1.495，95%CI：1.127~1.982）及完全性胆道梗阻（OR=1.385，95%CI：1.123~1.709）是MOJ患者PTCD术后胆道感染的独立危险因素（P<0.05）。结论 MOJ患者PTCD术后胆道感染发生率较高，病原菌以革兰阴性菌为主；高龄、术前长期黄疸、胆道支架置入、术后引流不通畅及完全性胆道梗阻是术后胆道感染的独立危险因素，临床应针对上述高危因素制定个体化感染预防方案并合理选用抗菌药物。 |
| 英文摘要: |
| Objective To investigate the incidence of biliary tract infection in patients with malignant obstructive jaundice (MOJ) after percutaneous transhepatic cholangial drainage (PTCD), and to analyze the distribution of pathogenic bacteria and risk factors. Methods The clinical data of 395 MOJ patients who underwent PTCD in Xinyang Central Hospital from January 2022 to January 2026 were retrospectively analyzed. According to whether biliary tract infection occurred after operation, they were divided into the infection group (51 cases) and the control group (344 cases). The general data of patients, basic diseases, surgical operation factors, postoperative management factors, tumor-related factors and preoperative laboratory indexes were collected. The incidence of biliary tract infection and the distribution of pathogenic bacteria were analyzed. The independent risk factors of biliary tract infection after PTCD in patients with MOJ were analyzed. Results The incidence of biliary tract infection in 395 MOJ patients after PTCD was 12.91%. 55 strains of pathogenic bacteria were detected in 51 patients with biliary tract infection, of which 41 strains (74.55%) were Gram-negative bacteria, mainly Escherichia coli (38.18%) and Pseudomonas aeruginosa (23.64%). The proportion of age ≥ 75 years old, preoperative jaundice days ≥ 21 d, biliary stent implantation, postoperative bile drainage obstruction and complete biliary obstruction in the infection group were higher than those in the control group (P<0.05). Age ≥ 75 years old (OR=1.322, 95%CI: 1.053~1.659), preoperative jaundice days ≥ 21 d (OR=1.368, 95%CI: 1.056~1.771), biliary stent implantation (OR=1.354, 95%CI: 1.083~1.693), postoperative bile drainage obstruction (OR=1.495, 95%CI: 1.127~1.982) and complete biliary obstruction (OR=1.385, 95%CI: 1.123~1.709) were independent risk factors for biliary tract infection after PTCD in patients with MOJ (P<0.05). Conclusion The incidence of biliary tract infection after PTCD in MOJ patients was high, and the pathogenic bacteria were mainly Gram-negative bacteria. Advanced age, long-term preoperative jaundice, biliary stent implantation, postoperative drainage obstruction and complete biliary obstruction are independent risk factors for postoperative biliary tract infection. Clinically, individualized infection prevention programs should be formulated for the above high-risk factors and antibiotics should be rationally selected. |
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