Ou Yangyang, Li Jianjun, Liang Chunfeng, Hu Chongyuan, Yao Ming, Huang Yubin, Cai Xiaoyong, Yan Yihe
Department of General Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China.
Surg Endosc. 2024 Apr;38(4):2050-2061. doi: 10.1007/s00464-024-10737-7. Epub 2024 Mar 1.
Choledochoscopy is a highly effective approach for managing intrahepatic bile duct stones (IHDs). However, postoperative infection is a common complication that significantly impacts treatment outcomes. Despite its clinical relevance, the risk factors associated with this procedure remain largely unexplored.
This study focused on a consecutive cohort of patients who underwent choledochoscopy for IHDs at our institution between January 2016 and December 2022. The primary objective was to analyze the relationship between various clinical factors and postoperative infection, and to compare the postoperative infection of different choledochoscopic procedures.
The study cohort consisted of 126 patients, with 60 individuals (47.6%) experiencing postoperative infection. Notably, preoperative biliary obstruction (odds ratio [OR] 1.861; 95% confidence interval [CI] 1.314-8.699; p = 0.010) and operation time (OR 4.414; 95% CI 1.635-12.376; p = 0.004) were identified as risk factors for postoperative infection. Additionally, biliary tract infections (60.00%) were primarily responsible for postoperative infection, with Escherichia coli (47.22%) being the predominant bacterial strain identified in bile cultures. Furthermore, biliary tract obstruction (OR 4.563; 95% CI 1.554-13.401; p = 0.006) and body mass index (BMI) (OR 1.186; 95% CI 1.015-1.386; p = 0.031) were determined to be independent risk factors for postoperative biliary tract infection.
The occurrence of postoperative infection in patients undergoing choledochoscopy was primarily associated with the duration of the operation and the presence of preoperative biliary obstruction.
胆管镜检查是治疗肝内胆管结石（IHD）的一种高效方法。然而，术后感染是一种常见并发症，会显著影响治疗效果。尽管其具有临床相关性，但与该手术相关的危险因素在很大程度上仍未得到充分探索。
本研究聚焦于2016年1月至2022年12月期间在我院接受胆管镜检查治疗IHD的连续队列患者。主要目的是分析各种临床因素与术后感染之间的关系，并比较不同胆管镜手术的术后感染情况。
该研究队列由126例患者组成，其中60例（47.6%）发生术后感染。值得注意的是，术前胆道梗阻（比值比[OR]1.861；95%置信区间[CI]1.314 - 8.699；p = 0.010）和手术时间（OR 4.414；95% CI 1.635 - 12.376；p = 0.004）被确定为术后感染的危险因素。此外，胆道感染（60.00%）是术后感染的主要原因，胆汁培养中鉴定出的主要细菌菌株为大肠杆菌（47.22%）。此外，胆道梗阻（OR 4.563；95% CI 1.554 - 13.401；p = 0.006）和体重指数（BMI）（OR 1.186；95% CI 1.015 - 1.386；p = 0.031）被确定为术后胆道感染的独立危险因素。
接受胆管镜检查的患者术后感染的发生主要与手术持续时间和术前胆道梗阻的存在有关。
