摘要
目的了解恶性梗阻性黄疸患者胆汁菌群分布情况，探讨影响恶性梗阻性黄疸患者胆汁细菌培养阳性的相关因素。方法对2007年10月-2008年10月入住复旦大学附属华山医院外科的65例恶性梗阻性黄疸患者病例资料进行回顾性分析。对可能影响恶性梗阻性黄疸患者胆汁细菌检出的相关风险因素包括：年龄、胆道手术史、皮肤巩膜黄染时间、血清谷丙转氨酶水平、总胆红素水平、CA19-9水平、肿瘤大小、梗阻部位、有无胆道感染临床表现及APACHEⅡ评分进行单因素和多因素分析。结果送检65例胆汁标本，培养结果阳性25例（38．5％），其中革兰阴性菌21株（占72．4％），革兰阳性菌6株（占20．7％），真菌2株（6．9％）。单因素分析显示可能影响恶性梗阻性黄疸患者胆汁细菌培养阳性率的相关因素是：年龄、胆道手术史、胆道梗阻部位、胆道感染症状和APACHEⅡ评分。多因素分析显示：年龄、胆道手术史、胆道梗阻部位和APACHEⅡ评分是独立的危险因素。结论年龄、胆道手术史、胆道梗阻部位和APACHEⅡ评分是恶性梗阻性黄疸患者胆汁细菌培养阳性的独立危险因素。
Objective To survey the biliary flora in patients with obstructive jaundice due to pancreatic head cancer, also the multiple factors which affect the positive findings of bile culture in these patients. Methods The information of 65 patients with obstructive jaundice due to pancreatic head cancer, who admitted to surgery in Huashan Hospital from October 2007 to October 2008 were reviewed retrospectively. The factors which may potentially affect the detection of bile pathogen in patients with malignant obstructive jaundice were studied with univarite analysis and multivariate analysis, including age, history of biliary surgery, yellow stained time, serum alanine aminotransferase level, serum bilirubin level, CA19-9 level, tumor size, site of obstruction, with or without clinical manifestations of biliary infection, and APACHE Ⅱ score. Results Twenty-five positive cuhures happened in 65 bile samples （38.5%）, including 21 strains of Gram-negative bacilli （72.4%）, 6 strains of Gram-positive bacteria （20.7%）, and 2 strains of fungi （6.9%）. Univariate analysis showed that the relevant factors which may affect the rate of posi- tive bile culture in patients with malignant obstructive jaundice were age, history of biliary surgery, biliary obstruction site, biliary tract infection symptoms and APACHE Ⅱ score. Multivariate analysis showed that age, history of biliary surgery, biliary obstruction site and APACHE Ⅱ score were independent risk factors. Conclusion Age, history of biliary surgery, biliary obstruction site and APACHE Ⅱ score were independent risk factors which led to positive findings of bile cultures in patients with obstructive jaundice due to pancreatic head cancer.
出处
《国际外科学杂志》
2012年第10期676-680,共5页
International Journal of Surgery
基金
上海市科委“创新行动计划”（NO.08411954300）
关键词
胰腺肿瘤
黄疸
阻塞性
胆汁
细菌
Pancreatic neoplasms
Jaundice, obstructive
Bile
Bacteria
