發(fā)布時間：2018-06-07 09:12

  本文選題：微波消融治療 + 膽腸吻合術��； 參考：《中國人民解放軍醫(yī)學院》2017年碩士論文

【摘要】：目的:研究腸道準備+針對性抗生素應用在膽腸吻合術后肝腫瘤微波消融后肝膿腫預防的臨床應用價值。方法:收集2008年12月至2015年6月21位既往有膽腸吻合術病史在我科行超聲引導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,消融前未行腸道準備,肝腫瘤消融治療后常規(guī)應用單一抗生素治療;B組11人,患者肝腫瘤消融前給予腸道準備、圍消融期針對性聯(lián)合應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)進行治療。比較兩組患者消融治療后3個月內消融相關發(fā)熱發(fā)生率、菌血癥發(fā)生率、肝內感染發(fā)生率、發(fā)熱持續(xù)時間、住院時間。結果: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),無菌血癥及肝內感染發(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)時間及住院時間明顯低于 A 組患者(p=0.002、0.0030.05)。結論:圍消融期給予腸道準備+針對性抗生素治療可顯著降低膽腸吻合術后患者肝腫瘤微波消融后患者發(fā)熱、菌血癥、及肝內感染的發(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.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7

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本文編號：1990647