Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico.
Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, C.P.14080, México, Distrito Federal, Mexico.
J Gastrointest Surg. 2017 Oct;21(10):1613-1619. doi: 10.1007/s11605-017-3497-8. Epub 2017 Jul 25.
BACKGROUND/PURPOSE: The study aims to describe the clinical features, microbiology, and associated factors of acute cholangitis (AC) after bilioenteric anastomosis (BEA) for biliary duct injury (BDI). Additionally, we assessed the performance of the Tokyo Guidelines 2013 (TG13) recommendations in these patients.
We conducted a case-control study of 524 adults with a history of BEA for BDI from January 2000 to January 2014. A propensity score adjustment was performed for the analysis of the independent role of the main factors identified during the univariate logistic regression procedure.
We identified 117 episodes of AC in 70 patients; 51.3% were definitive AC according to the TG13 diagnostic criteria, and 39.3% did not fulfill the imaging criteria of AC. A history of post-operative biliary complications (OR 2.55, 95% CI 1.38-4.70) and the bile duct confluence preservation (OR 0.46, 95% CI 0.24-0.87) were associated with AC. Eighty-nine percent of the microorganisms were Enterobacteriaceae; of them, 28% were extended spectrum β-lactamase (ESBL) producers.
AC is a common complication after BEA and must be suspected even in the absence of imaging findings, particulary in patients with a history of post-operative biliary complications, and/or without bile duct confluence preserved. An empirical treatment for ESBL-producing Enterobacteriaceae may be appropriate in patients living in countries with a high rate of bacterial drug resistance.
背景/目的：本研究旨在描述胆肠吻合术（BEA）治疗胆管损伤（BDI）后急性胆管炎（AC）的临床特征、微生物学和相关因素。此外，我们评估了 2013 年东京指南（TG13）建议在这些患者中的应用效果。
我们对 2000 年 1 月至 2014 年 1 月期间接受 BEA 治疗 BDI 的 524 例成年人进行了病例对照研究。采用倾向评分调整法分析单变量逻辑回归过程中确定的主要因素的独立作用。
我们共发现 70 例患者中有 117 例 AC 发作，根据 TG13 诊断标准，51.3%为明确 AC，39.3%不符合 AC 的影像学标准。术后胆道并发症史（OR 2.55，95%CI 1.38-4.70）和胆管汇合保留（OR 0.46，95%CI 0.24-0.87）与 AC 相关。89%的微生物为肠杆菌科；其中，28%为产超广谱β-内酰胺酶（ESBL）的菌株。
AC 是 BEA 后的常见并发症，即使缺乏影像学发现，特别是在有术后胆道并发症史和/或胆管汇合未保留的患者中，也应怀疑 AC 的发生。对于生活在细菌耐药率较高的国家的患者，经验性治疗产 ESBL 肠杆菌科可能是合适的。
