摘要目的 探讨经内镜逆行胰胆管造影术(ERCP)后预防性使用抗菌药物对术后并发症的影响.方法 纳入2011年1月1日至2013年12月31日行ERCP的1 951例患者,将其分成术后预防性使用抗菌药物组(以下简称抗菌药物组)630例和术后未使用抗菌药物组(以下简称非抗菌药物组)1 321例.比较两组术后并发症发生情况.统计学分析采用卡方检验、单因素分析和多因素分析.结果 1 951例行ERCP的患者中,出现并发症者277例;101例(5.18％)为术后胰腺炎(PEP),54例(2.77％)为高淀粉酶血症,134例(6.87％)为胆道感染,8例(0.41％)为上消化道出血,肠梗阻和十二指肠穿孑孔各1例(0.05％).抗菌药物组术后胆道感染发生率为4.44％ (28/630),低于非抗菌药物组的8.02％ (106/1 321),差异有统计学意义(x2=8.546,P=0.030).抗菌药物组和非抗菌药物组PEP发生率分别为4.92％(31/630)和5.30％(70/1 321),术后高淀粉酶血症发生率分别为3.02％ (19/630)和2.65％(35/1 321),术后上消化道出血发生率分别为0.95％(6/630)和0.15％(2/1 321),术后肠梗阻发生率分别为0(0/630)和0.08％(1/1 321),术后十二指肠穿孑孔发生率分别为0.16％(1/630)和0(0/1 321),差异均无统计学意义(P均＞0.05).胆管癌(OR=2.93,95％CI 1.88～4.56,P＜0.01)、住院期间多次行ERCP(OR=2.53,95％CI 1.63～3.93,P＜0.01)为术后胆道感染的独立危险因素,行内镜下乳头括约肌切开术(OR=0.65,95％CI 0.44～0.97,P=0.030)和预防性使用抗菌药物(OR=0.64,95％CI 0.39～0.95,P=0.030)为其保护因素.结论 ERCP术后预防性使用抗菌药物可减少术后胆道感染的发生.有胆管癌、住院期间多次行ERCP和未行内镜下乳头括约肌切开术之一者,推荐术后预防性使用抗菌药物.

abstractsObjective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.