消化道清洁预防ERCP术后胆道感染的作用及机制

目的探讨口腔护理联合十二指肠冲洗在预防经内镜逆行胰胆管造影术（ERCP）术后胆道感染中的作用及机制。方法284例ERCP诊疗患者中，96例行阿米卡星干预（阿米卡星组），95例行生理盐水干预（盐水组），93例不加干预（对照组）。分别在十二指主乳头插管前、切开刀完成插管首次进入胆管时（即内镜操作初）和ERCP操作即将结束时（即内镜操作末）收集细菌标本并行细菌培养和菌落计数。统计分析3组ERCP术后胆管炎发生率以及不同检测点细菌检测结果。结果阿米卡星组、盐水组和对照组ERCP术后胆管炎发生率分别为7．3％（7／96）、8．4％（8／95）和18．3％（17／93），差异有统计学意义（χ2=6．861，P=0．032）；十二指肠主乳头插管前细菌培养阳性率分别为6．3％（6／96）、25．3％（24／95）和28．0％（26／93），差异有统计学意义（χ2=16．833，P=0．000）；内镜操作初细菌培养阳性率分别为6．3％（6／96）、16．8％（16／95）和24．7％（23／93），差异有统计学意义（χ2=12．206，P=0．002）；内镜操作末细菌培养阳性率分别为7．3％（7／96）、17．9％（17／95）和33．3％（31／93），差异有统计学意义（χ2=20．713，P=0．000）。结论ERCP诊疗可将肠道微生物逆行带入胆管，口腔护理联合十二指肠冲洗能减少胆管逆行微生物带入，从而能有效减少ERCP术后胆管炎的发生。

The mechanisms of digestive tract cleaning before ERCP for the prevention of post procedure cholangifts

Objective To evaluate the effectiveness of mouth care combined with intestinal and en- doscopic working channel flushing for ERCP related cholangitis and to investigate the mechanisms. Methods A total of 284 patients who underwent ERCP were divided into the amikacin group （ n = 96）, the saline group （ n = 95 ） and the control group （ n = 93 ）. Specimens were collected before eannulation （ Sample 1 ） , the first access to the bile duct （ Sample 2） and at the end of ERCP （ Sample 3 ）. All the samples un- derwent bacterial culture and colony counting. Incidence of ERCP related cholangitis and bacterial results were recorded. Results The incidences of ERCP related cholangitis were 7.3 % （ 7/96 ）, 8.4% （ 8/95 ） and 18.3% （17/93）in amikacin group, saline group and control group respectively, with significant differ- ences among three groups （χ2 =6. 861 ,P =0. 032）. The positive rate of bacterial culture of Sample 1 in the amikaein group , saline group and control group were 6. 3% （6/96）, 25.3% （24/95） and 28.0% （26/93） （χ2 = 16. 833,P = 0. 000）, respectively. The positive rate of bacterial culture of Sample 2 in ami- kacin group , saline group and control group were 6. 3% （6/96）, 16. 8% （ 16/95 ） and 24.7% （23/93） （χ2 = 12. 206 ,P =0. 002） ,respectively. The positive rate of bacterial culture of Sample 3 in amikacin group , saline group and control group were 7.3% （7/96）, 17.9% （17/95） and 33.3% （31/93） （χ2 = 20. 713, P = 0. 000）, respectively. Conclusion The procedure of ERCP can bring the intestinal bacteria in- to the bile duct, which could be reduced by mouth care combined with intestinal and endoscopic workingchannel flushing. And the incidence of ERCP related cholangitis can be effectively reduced.