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目的分析恶性梗阻性黄疸合并胆系感染的致病菌及其耐药性,探讨胆系感染对恶性梗阻性黄疸治疗疗效的影响。方法206例恶性梗阻性黄疸患者,合并胆系感染者共103例。其中,术前合并不同程度的胆系感染者85例,术后新发,再发胆系感染18例,根据感染程度,给予保肝、支持、抗感染治疗。合并感染者行血及胆汁细菌培养加药敏,选用敏感有效的抗生素抗感染治疗。全部病人根据梗阻情况,行经皮经肝胆管引流术或胆管支架置入术。结果103例合并胆系感染者,82例胆系感染得到控制,21例未控并死亡。胆系感染血胆汁培养阳性者,以革兰氏阴性(G-)肠杆菌为主,耐药菌增多,产超广谱β-内酰胺酶(ESBLs)的阳性事逐年升高,碳青霉烯类药物的疗效显著。合并感染组和无感染组肝功能恢复差别显著。结论胆系感染是恶性梗阻性黄疸最主要的严重并发症,致病菌主要是革兰氏阴性肠杆菌。及时有效的控制感染,是提高手术成功率延长患者生存期的重要保证。
Objective To analyze the pathogenic bacteria and drug resistance of malignant obstructive jaundice with gallbladder infection and to explore the effect of gallbladder infection on the curative effect of malignant obstructive jaundice. Methods 206 patients with malignant obstructive jaundice, gallbladder infection in a total of 103 cases. Among them, 85 cases were preoperatively combined with different levels of biliary infection, and 18 cases were newly diagnosed and recurred after biliary infection. According to the degree of infection, hepatoprotective, supportive and anti-infective treatments were given. Infection with blood and bile bacterial culture plus drug sensitivity, the selection of sensitive and effective anti-infective antibiotics. All patients under obstruction, percutaneous transhepatic biliary drainage or biliary stenting. Results 103 cases of patients with gall bladder infection, 82 cases of biliary infection were controlled, 21 cases were uncontrolled and died. Gram-negative blood bile culture positive persons, Gram-negative (G-) Enterobacteriaceae, resistant bacteria increased, the production of extended-spectrum β-lactamase (ESBLs) positive events increased year by year, Alkene drugs have a significant effect. There was a significant difference in the recovery of liver function between the infected group and the non-infected group. Conclusion Gallbladder infection is the most serious and serious complication of malignant obstructive jaundice. The pathogens are mainly Gram-negative enterobacter. Timely and effective control of infection is to improve the success rate of surgery to extend the survival of patients an important guarantee.