Howard Thomas J, Yu Jian, Greene Ryan B, George Virgilio, Wairiuko George M, Moore Seth A, Madura James A
Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
J Gastrointest Surg. 2006 Apr;10(4):523-31. doi: 10.1016/j.gassur.2005.08.011.
The aim of this study was to correlate the bactibilia found after preoperative biliary stenting with that of the bacteriology of postoperative infectious complications in patients with obstructive jaundice. One hundred thirty-eight patients (83% malignant and 17% benign etiologies) with obstructive jaundice had both their bile and all postoperative infectious complications cultured. Eighty-six (62%) had preoperative biliary stents (stent group) and 52 (38%) did not (no-stent group). There were no differences for age, sex, incidence of malignancy, type of operation, estimated blood loss, transfusion requirements, hospital length of stay, morbidity, or mortality rates between the two groups. Of 31 infectious complications, 23 were in the stent group and eight were in the no-stent group (P > 0.05), but only 13 (42%) infectious complications had bacteria that were also cultured from the bile. Only wound infection (P = 0.03) and bacteremia (P = 0.04) were more likely to occur in stented patients. Taken together, these data show that preoperative biliary stenting increases the incidence of bactibilia, bacteremia, and wound infection rates but does not increase morbidity, mortality, or hospital length of stay. Jaundiced patients can undergo preoperative biliary stenting while maintaining an acceptable postoperative morbidity rate.
本研究的目的是将术前胆道支架置入术后发现的胆系细菌与梗阻性黄疸患者术后感染性并发症的细菌学情况进行关联分析。138例梗阻性黄疸患者（恶性病因占83%，良性病因占17%）均接受了胆汁及所有术后感染性并发症的培养。86例（62%）患者术前放置了胆道支架（支架组），52例（38%）未放置（无支架组）。两组在年龄、性别、恶性肿瘤发生率、手术类型、估计失血量、输血需求、住院时间、发病率或死亡率方面均无差异。在31例感染性并发症中，23例发生在支架组，8例发生在无支架组（P>0.05），但只有13例（42%）感染性并发症的细菌也在胆汁中培养到。仅伤口感染（P=0.03）和菌血症（P=0.04）在放置支架的患者中更易发生。综合来看，这些数据表明术前胆道支架置入增加了胆系细菌感染、菌血症和伤口感染率，但并未增加发病率、死亡率或住院时间。黄疸患者可以在维持可接受的术后发病率的情况下接受术前胆道支架置入。
