恶性梗阻性黄疸患者PTCD术后发生胆系感染的危险因素

目的　系统评估恶性梗阻性黄疸患者经皮肝穿胆道引流术（PTCD）术后发生胆系感染的危险因素。方法　检索建库至2022年4月期间PubMed、Embase、Cochrane、Web of Science、CBM、CNKI、万方、维普数据库，根据纳入、排除标准，对有关资料进行筛选和提取。利用纽卡斯尔-渥太华量表（NOS）对文献质量进行评估，利用RevMan5.3软件对其进行meta分析。结果　纳入的6篇文献均为病例对照研究，病例组237例，对照组582例。恶性梗阻性黄疸患者PTCD术后发生胆系感染的主要危险因素为既往胆道手术史、术前肝功能C级、胆道外引流留置>1个月、胆道再狭窄，对应OR值及95%可信区间分别为4.42（2.31～8.46）、11.62（5.22～25.84）、8.39（5.17～13.641）、8.07（1.86～34.98），“年龄≥60岁”因素无统计学意义，“胆道梗阻位置”因素存在争议。结论　既往胆道手术史、术前肝功能C级、胆道外引流留置>1个月、胆道再狭窄是术后发生胆系感染的主要危险因素；年龄因素和胆道梗阻位置因素对于术后发生胆系感染的预测价值有待进一步探讨。医护人员应对以上因素予以重点关注，采取针对性预防措施以减少术后胆系感染的发生。

Risk factors of biliary infection after PTCD for patients with malignantobstructive jaundice

Objective　To systematically assess the risk factors of biliary infection afterpercutaneous transhepatic cholangio drainage (PTCD) for patients with malignantobstructive jaundice. Methods　The PubMed, Embase,Cochrane, Web of Science, CBM, CNKI, Wan fang, and VIP databases were searchedfor literatures from their establishment to April 2022. According to theselection and exclusion criteria, the relevant data were screened andextracted. The literatures' quality was assessed using the Newcastle-OttawaScale (NOS), and meta-analysis was performed using the RevMan5.3 software. Results　The 6 included literatures were all case-controlstudies, with 237 cases in the case group and 582 in the control group. Themain risk factors of biliary infection after PTCD for malignant obstructivejaundice were biliary surgery history, grade C liver function before operation,extrabiliary drainage indwelling time >1 month, and the appearance ofbiliary restenosis. The combined OR values and 95%CI of the above factorswere 4.42 (2.31-8.46), 11.62 (5.22-25.84), 8.39 (5.17-13.641), and 8.07(1.86-34.98), respectively; the "age ≥60 years old" factor was not statisticallysignificant; and the "location of biliary obstruction" factor wascontroversial. Conclusions　Biliary surgeryhistory, grade C liver function before operation, extrabiliary drainageindwelling time > 1 month, and the appearance of biliary restenosis are themain risk factors for postoperative biliary infection. The predictive value ofage and location of biliary obstruction for postoperative biliary infectionneeds to be further explored. Healthcare workers should focus on these factorsand take targeted precautions to reduce the incidence of postoperative biliaryinfection.