摘要

The purpose of this study was to identify patients who were more likely to experience septicemia after endoscopic biliary drainage. In an attempt to determine the relative importance of each risk factor and their possible interdependancy to more precisely identify high-risk patients and to deduce some guidelines for prevention, a discriminant regression analysis of risk factors for septicemia was used. Clinical, biological, and radiological data of 34 consecutive patients who experienced septicemia within 3 days after endoscopic biliary stenting were reviewed retrospectively and compared with data of a group of 71 patients without any septic complication. If only data available before the procedure were used in the discriminant analysis, prior cholangitis and leucocytosis appeared as significant risk factors, but the linear combination of these data could not predict septicemia in 50% of cases. When information concerning the quality of drainage after the procedure was introduced into the analysis, 91% of the septicemic patients were identified, and other expected risk factors such as the nature of the stricture, the type of drainage, or prior cholangitis and leukocytosis had no or marginal predictive values. Patients referred from centers where duodenoscopes might have been poorly disinfected appeared to be at higher risk for Pseudomonas aeruginosa septicemia. These results emphasize the crucial role of the quality of drainage as a risk for septicemia. Regarding the prevention of infection, it is concluded from this study that (a) pure diagnostic endoscopic retrograde cholangiopancreatography should be avoided in obstructed patients if drainage cannot be performed during the same procedure; (b) drainage should be as complete as possible; (c) antibiotics should be administered before ERCP to every patient with suspected obstructive jaundice and should cover P. aeruginosa if local epidemiological data suggest that there is a problem with disinfection of the endoscopes; and (d) the quality of drainage should guide the duration of antibiotic prophylaxis.

译文

这项研究的目的是确定哪些患者在内镜下胆汁引流后更有可能出现败血症。为了确定每个风险因素的相对重要性以及它们可能的相互依存性,以便更准确地识别高风险患者,并推断出一些预防指南, 使用了败血症危险因素的判别回归分析。回顾性分析了 34 例连续出现败血症的患者的临床、生物学和放射学数据,这些患者在内镜下支架置入术后 3 天内出现败血症,并与 71 例无任何败血症并发症的患者的数据进行了比较。如果在判别分析中仅使用程序前可用的数据,先前的胆管炎和白细胞增多似乎是重要的危险因素,但是这些数据的线性组合不能预测 50% 的病例的败血症。当关于程序后引流质量的信息被引入分析时,91% 的败血症患者被确认,以及其他预期的风险因素,如狭窄的性质, 引流类型,或先前的胆管炎和白细胞增多没有或边缘预测值。从十二指肠镜可能消毒不良的中心转诊的患者患铜绿假单胞菌败血症的风险更高。这些结果强调了引流质量作为败血症风险的关键作用。关于预防感染,本研究得出的结论是 (a) 如果在同一过程中不能进行引流,应避免阻塞患者进行纯诊断性内窥镜逆行胰胆管造影术; (b) 排水应尽可能完整; (c)对于每一位疑似梗阻性黄疸患者,应在 ERCP 术前给予抗生素,并应覆盖 P。如果当地流行病学数据表明内窥镜消毒存在问题,则为铜绿假单胞菌; 以及 (d) 引流质量应指导抗生素预防的持续时间。

endoscopic biliary stenting

消化 引流手术 手术操作
概述  :  

内镜下支架置入术是利用内镜在梗阻或狭窄的消化道内放置支架以重建消化道畅通功能的技术。适用于食管癌性梗阻、食管癌性狭窄、幽门及十二指肠恶性梗阻、大肠癌性梗阻、良性胆胰管狭窄、胆胰内引流、吻合口瘘等。对于晚期癌性梗阻或狭窄的患者,此术属姑息性手术。内镜下胆道支架置入术即在胆道内置入支架进行治疗。   胆管支架指征 一、外科手术前胆管引流 术前胆管引流PBD是一种常见做法,据报道其发生率由1995年的30%

endoscopic 英 /,endə'skɒpɪk/  美 /,ɛndəs'kɑpɪk/

释义   adj. 内窥镜的;用内窥镜检查的

例句   ERCP is safe when performed by surgeons whohave had specific training and 

are experienced in this specialized endoscopic procedure. 在经过特别训练并具有丰富经验的外科医师的操作下,内镜逆行胰胆管造影(ERCP)是安全的。

 

biliary 英 /ˈbɪliəri/  美 /ˈbɪlieri/

释义   adj. 胆的;胆汁的;输送胆汁的

例句   Seen here is the major differential diagnosis of biliary atresia: this is neonatal giant cell hepatitis.  此图为胆道闭锁的主要不同诊断:这是一例新生儿巨细胞肝炎。

 

stenting  /stentɪŋ/ 

释义   n. 支架(术)

例句   Objective: to investigate the application of angioplasty and stenting in the treatment of Symptomatic middle cerebral artery stenosis.  目的:研究血管内支架成型术在治疗症状性大脑中动脉狭窄的应用。

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