术前胆道引流对胰头切除术后孤立性感染性并发症（iiC）的临床影响：一项回顾性研究。
The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection-a retrospective study.
机构信息
Department of Surgery, Immanuel Clinic Rüdersdorf, University Clinic of Brandenburg Medical School, Seebad 82/83, Rüdersdorf b, 15562, Berlin, Germany.
Department of General and Visceral Surgery, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
出版信息
BMC Surg. 2022 Feb 26;22(1):71. doi: 10.1186/s12893-021-01366-1.
BACKGROUND
The perioperative morbidity after pancreatoduodenectomy (PD) is mostly influenced by intraabdominal complications which are often associated with infections. In patients with preoperative biliary drainage (PBD), the risk for postoperative infections may be even elevated. The aim of this study is to explore if isolated infectious complications without intraabdominal focus (iiC) can be observed after PD and if they are associated to PBD and antibiotic prophylaxis with potential conclusions for their treatment.
METHODS
During a 10-year period from 2009 to 2019, all consecutive PD were enrolled prospectively in a database and analyzed retrospectively. Bacteriobilia (BB) and Fungibilia (FB) were examined by intraoperatively acquired smears. A perioperative antibiotic prophylaxis was performed by Ampicillin/Sulbactam. For this study, iiC were defined as postoperative infections like surgical site infection (SSI), pneumonia, unknown origin etc. Statistics were performed by Fisher's exact test and Mann Whitney U test.
RESULTS
A total of 426 PD were performed at the Vivantes Humboldt-hospital. The morbidity was 56% (n = 238). iiC occurred in 93 patients (22%) and accounted for 38% in the subgroup of patients with postoperative complications. They were not significantly related to BB and PBD but to FB. The subgroup of SSI, however, had a significant relationship to BB and FB with a poly microbial profile and an accumulation of E. faecalis, E. faecium, Enterobacter, and Candida. BB was significantly more frequent in longer lay of PBD. Resistance to standard PAP and co-existing resistance to broad spectrum antibiotics is frequently found in patients with iiC. The clinical severity of iiC was mostly low and non-invasive therapy was adequate. Their treatment led to a significant prolongation of the hospital stay.
CONCLUSIONS
iiC are a frequent problem after PD, but only in SSI a significant association to BB and FB can be found in our data. Therefore, the higher resistance of the bacterial species to routine PAP, does not justify broad spectrum prophylaxis. However, the identification of high-risk patients with BB and PBD (length of lay) is recommended. In case of postoperative infections, an early application of broad-spectrum antibiotics and adaption to microbiological findings from intraoperatively smears may be advantageous.
背景
胰十二指肠切除术（PD）术后的围手术期发病率主要受腹腔内并发症的影响，这些并发症通常与感染有关。在术前胆道引流（PBD）的患者中，术后感染的风险甚至可能会升高。本研究旨在探讨 PD 术后是否会出现孤立性感染并发症（iiC）而无腹腔内焦点，并探讨其与 PBD 和抗生素预防的关系，为其治疗提供潜在结论。
方法
在 2009 年至 2019 年的 10 年期间，连续前瞻性地将所有 PD 纳入数据库并进行回顾性分析。术中采集的涂片检查胆菌血症（BB）和真菌血症（FB）。围手术期预防性应用氨苄西林/舒巴坦。在本研究中，iiC 被定义为术后感染，如手术部位感染（SSI）、肺炎、不明原因等。统计学分析采用 Fisher 确切检验和 Mann Whitney U 检验。
结果
共在 Vivantes Humboldt 医院进行了 426 例 PD，发病率为 56%（n=238）。iiC 发生在 93 例患者（22%），术后并发症患者亚组中占 38%。它们与 BB 和 PBD 无显著关系，但与 FB 有关。然而，SSI 亚组与 BB 和 FB 有显著关系，具有多微生物谱，并积累了屎肠球菌、粪肠球菌、肠杆菌和假丝酵母。BB 在 PBD 时间较长的患者中更为常见。iiC 患者对标准 PAP 的耐药性和同时存在的广谱抗生素耐药性较为常见。iiC 的临床严重程度大多较低，非侵入性治疗即可。他们的治疗导致住院时间显著延长。
结论
iiC 是 PD 后常见的问题，但在我们的数据中，只有在 SSI 中才能发现 BB 和 FB 与 iiC 有显著关系。因此，细菌对常规 PAP 的耐药性较高，并不 justifies 广谱预防。然而，建议对存在 BB 和 PBD（引流时间）的高危患者进行识别。在术后感染的情况下，早期应用广谱抗生素并根据术中涂片的微生物学结果进行调整可能是有利的。
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