经皮经肝胆道引流胆管造影和交换相关的胆管炎和败血症的发生率：肝移植患者与非肝移植患者的比较。

Incidence of cholangitis and sepsis associated with percutaneous transhepatic biliary drain cholangiography and exchange: a comparison between liver transplant and native liver patients.

机构信息

Department of Imaging Sciences, University of Rochester, Rochester, NY, USA.

出版信息

AJR Am J Roentgenol. 2011 Jan;196(1):W73-7. doi: 10.2214/AJR.09.3925.

DOI:10.2214/AJR.09.3925

PMID:21178036

Abstract

OBJECTIVE

The purpose of our study was to determine the rate of sepsis and cholangitis associated with percutaneous biliary drain cholangiography and subsequent drain exchanges and to compare the incidence of these complications between patients with liver transplants and those with native livers.

MATERIALS AND METHODS

A retrospective review of 154 consecutive patients (100 with liver transplants and 54 with native livers) who underwent a total of 910 percutaneous biliary drain cholangiography examinations and exchanges (January 2005 to July 2008) was performed. Cholangitis was defined as fever (> 38.5°C) within 24 hours after the intervention, and sepsis included cholangitis in addition to hemodynamic instability.

RESULTS

The overall incidence of cholangitis and sepsis after percutaneous biliary drain exchanges was 2.1% (n = 19/910 exchanges) and 0.4% (n = 4/910 exchanges), respectively. There was no statistically significant difference in complications between liver transplant patients versus nontransplant patients (p = 0.34 for cholangitis and p = 1.00 for sepsis). The mean hospital stay due to postprocedural complications was 2.4 days for observation and supportive treatment. None of these patients required an intensive care stay. Mean percutaneous biliary drain dwell time in liver transplant and nontransplant patients was 6.2 and 1.5 months, respectively. Transplant patients were significantly younger (54 versus 67 years; p << 0.05), male predominant (70% vs 52%, p = 0.035), and had more severe liver disease (12.2 vs 8.0 Model for End-Stage Liver Disease [MELD] scores; p << 0.05).

CONCLUSION

Percutaneous biliary drain cholangiography and exchange is associated with a low rate of postprocedure cholangitis and sepsis. These complications require brief hospitalizations. Liver transplant patients do not have an increased risk of complications despite higher MELD scores and longer intubation periods.

摘要

目的

本研究旨在确定经皮胆道引流管胆管造影及后续引流管更换相关的脓毒症和胆管炎的发生率，并比较肝移植患者与非肝移植患者的这些并发症的发生率。

材料和方法

对 2005 年 1 月至 2008 年 7 月期间接受了总共 910 次经皮胆道引流管胆管造影和更换术（100 例肝移植患者和 54 例非肝移植患者）的 154 例连续患者进行了回顾性分析。胆管炎的定义为术后 24 小时内发热（>38.5°C），败血症包括胆管炎以及血流动力学不稳定。

结果

经皮胆道引流管更换术后胆管炎和败血症的总发生率分别为 2.1%（910 次交换中有 19 次）和 0.4%（910 次交换中有 4 次）。肝移植患者与非移植患者的并发症发生率无统计学差异（胆管炎为 p = 0.34，败血症为 p = 1.00）。由于术后并发症而住院观察和支持治疗的平均时间为 2.4 天。这些患者均无需入住重症监护病房。肝移植和非肝移植患者的经皮胆道引流管留置时间分别为 6.2 个月和 1.5 个月。肝移植患者明显更年轻（54 岁与 67 岁；p << 0.05）、男性为主（70%与 52%，p = 0.035），且肝脏疾病更严重（12.2 分与 8.0 分的终末期肝病模型评分；p << 0.05）。