胆肠吻合术后肝肿瘤微波消融后肝脓肿预防的初步研究

发布时间：2018-06-07 09:12

本文选题：微波消融治疗 + 胆肠吻合术　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的:研究肠道准备+针对性抗生素应用在胆肠吻合术后肝肿瘤微波消融后肝脓肿预防的临床应用价值。方法:收集2008年12月至2015年6月21位既往有胆肠吻合术病史在我科行超声引导下微波消融治疗肝肿瘤患者的资料。21位患者分为A、B两组,A组患者10人,消融前未行肠道准备,肝肿瘤消融治疗后常规应用单一抗生素治疗;B组11人,患者肝肿瘤消融前给予肠道准备、围消融期针对性联合应用抗菌谱可覆盖肠杆菌及粪(屎)球菌的抗生素(注射用亚胺培南西司他丁钠1 g 1/12h,力奈唑胺0.6 g 1 /12 h)进行治疗。比较两组患者消融治疗后3个月内消融相关发热发生率、菌血症发生率、肝内感染发生率、发热持续时间、住院时间。结果:A组患者消融后发热发生率为90% (9/10),菌血症发生率60% (6/10),肝内感染的发生率70%(7/10,包括消融区继发感染形成脓肿发生率60%(6/10)及肝内胆道感染发生率10%(1/10)。B组患者消融后发热发生率为18.2%(2/11),无菌血症及肝内感染发生。B组发热发生率、菌血症发生率、肝脓肿发生率明显低于A组(p=0.002、0.004、0.0040.05), B组患者发热持续时间及住院时间明显低于 A 组患者(p=0.002、0.0030.05)。结论:围消融期给予肠道准备+针对性抗生素治疗可显著降低胆肠吻合术后患者肝肿瘤微波消融后患者发热、菌血症、及肝内感染的发生率。
[Abstract]:Objective: to study the clinical value of enteric preparation antibiotics in preventing liver abscess after choledochojejunostomy after microwave ablation. Methods: from December 2008 to June 2015, 21 patients with history of choledochojejunostomy treated with ultrasound guided microwave ablation for liver neoplasms were collected. 21 patients were divided into two groups: group A (n = 10) and group A (n = 10). 11 patients in group B were treated with single antibiotic after ablation of liver tumor. The patients were given intestinal preparation before ablation. Peri-ablation targeted combination of antimicrobial spectrum can cover Enterobacter faecium antibiotics (1 g / 12 h of imipenem sodium for injection and 0.6 g / 1 / 12 h of lenazolidomide for 1 g / 12 h). The incidence of ablation associated fever, bacteremia, intrahepatic infection, duration of fever and hospital stay were compared between the two groups within 3 months after ablation. Results the incidence of fever, bacteremia, intrahepatic infection, secondary infection and abscess in group A were 90% or 9 / 10, 60% or 6 / 10, 70 / 7 / 10, respectively, including 606 / 10 of secondary infection in ablation area and 10 / 10% of patients in group B with intrahepatic biliary tract infection. The incidence of asepsis and intrahepatic infection was 18. 2 / 11. The incidence of fever in group B. The incidence of bacteremia and liver abscess was significantly lower than that of group A (P 0.002P 0.004), and the duration of fever and hospitalization in group B was significantly lower than that of group A (P 0.002 0. 0030.05). Conclusion: peri-ablation with appropriate antibiotics can significantly reduce the incidence of fever, bacteremia and intrahepatic infection after microwave ablation of liver tumors in patients with choledochojejunostomy.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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