经内镜逆行胰胆管造影术诊断和治疗肝移植术后胆道真菌感染二例

目的探讨肝移植术后胆道真菌感染诊治的有效方法。方法2例肝移植术后临床表现有严重胆系感染者,经内镜鼻胆管引流获取胆汁进行涂片和/或培养证实胆道真菌感染合并细菌感染。根据胆汁培养和药物敏感试验结果进行针对性抗细菌治疗,并经鼻胆管给予氟康唑胆道冲洗和联合予以氟康唑或伊曲康唑静脉治疗。结果2例患者胆系真菌感染的病原菌分别为光滑假丝酵母菌及热带假丝酵母菌,经鼻胆管局部氟康唑冲洗治疗时间分别为19d和30d,静脉抗真菌治疗时间分别为27d和56d;2例患者均治愈。经13个月的随访未见胆系真菌感染复发。结论经内镜逆行胰胆管造影(ERCP)并获取胆汁进行真菌涂片、培养是诊断胆道真菌感染的关键。经鼻胆管局部给予氟康唑联合静脉抗真菌治疗胆道真菌感染应为一种安全有效的方案。保持胆道引流通畅对于胆道真菌感染治疗是极其重要的。

Diagnosis and treatment of patients with biliary fungal infection after liver transplantation by ERCP and naso-biliary drainage: two cases report

Objective To evaluate the diagnostic value of ERCP for fungal infection of biliary tract, and the efficacy of combination of local administration by nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection after liver transplantation.Methods Two patients after liver transplantation were diagnosed with fungal and bacteria mixing infection of biliary tract confirmed by culture of bile obtained by ERCP. Besides routine anti-bacteria therapy, the patients accepted local application of fluconazole through nasobiliary tube and intravenous fluconazole or itraconazole in terms of the results of in vitro susceptive test. Results The pathogens of 2 cases of fungal infection included candida tropicalis and candida albicans. The duration of intravenous antifungal therapy was 27 days and 56 days respectively, and that of local application of fluconazole through nasobiliary tube was 19 days and 30days. During a follow-up period of 13 months, no relapse of biliary tract fungal infection was observed. Conclusions Combining with typical clinical features of biliary tract infection, fungus detection of smear/culture of bile obtained by ERCP was the key-point for diagnosis of fungal infection of biliary tract. Local application through nasobiliary tube and intravenous fluconazole or itraconazole might be an effective and safe treatment of fungal infection of biliary tract.