本文選題：微波消融治療 + 膽腸吻合術(shù)�。� 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:研究腸道準(zhǔn)備+針對(duì)性抗生素應(yīng)用在膽腸吻合術(shù)后肝腫瘤微波消融后肝膿腫預(yù)防的臨床應(yīng)用價(jià)值。方法:收集2008年12月至2015年6月21位既往有膽腸吻合術(shù)病史在我科行超聲引導(dǎo)下微波消融治療肝腫瘤患者的資料。21位患者分為A、B兩組,A組患者10人,消融前未行腸道準(zhǔn)備,肝腫瘤消融治療后常規(guī)應(yīng)用單一抗生素治療;B組11人,患者肝腫瘤消融前給予腸道準(zhǔn)備、圍消融期針對(duì)性聯(lián)合應(yīng)用抗菌譜可覆蓋腸桿菌及糞(屎)球菌的抗生素(注射用亞胺培南西司他丁鈉1 g 1/12h,力奈唑胺0.6 g 1 /12 h)進(jìn)行治療。比較兩組患者消融治療后3個(gè)月內(nèi)消融相關(guān)發(fā)熱發(fā)生率、菌血癥發(fā)生率、肝內(nèi)感染發(fā)生率、發(fā)熱持續(xù)時(shí)間、住院時(shí)間。結(jié)果:A組患者消融后發(fā)熱發(fā)生率為90% (9/10),菌血癥發(fā)生率60% (6/10),肝內(nèi)感染的發(fā)生率70%(7/10,包括消融區(qū)繼發(fā)感染形成膿腫發(fā)生率60%(6/10)及肝內(nèi)膽道感染發(fā)生率10%(1/10)。B組患者消融后發(fā)熱發(fā)生率為18.2%(2/11),無(wú)菌血癥及肝內(nèi)感染發(fā)生。B組發(fā)熱發(fā)生率、菌血癥發(fā)生率、肝膿腫發(fā)生率明顯低于A組(p=0.002、0.004、0.0040.05), B組患者發(fā)熱持續(xù)時(shí)間及住院時(shí)間明顯低于 A 組患者(p=0.002、0.0030.05)。結(jié)論:圍消融期給予腸道準(zhǔn)備+針對(duì)性抗生素治療可顯著降低膽腸吻合術(shù)后患者肝腫瘤微波消融后患者發(fā)熱、菌血癥、及肝內(nèi)感染的發(fā)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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.7

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本文編號(hào)：1990647