术中胆囊与胆总管胆汁同步细菌培养对比研究

目的　了解胆石病病人胆道不同部位内胆汁的细菌学特点和药敏情况 ,指导术后抗生素应用。方法　 5 6例胆囊切除胆总管探查术病人同步作胆囊内胆汁和胆总管内胆汁细菌培养和药敏。结果　胆囊和胆总管内胆汁培养按双阳性率排列依次为急性化脓性胆管炎 (1 0 0 % )、胆源性胰腺炎 (5 7.1 % )、急性胆囊炎胆囊结石伴阻塞性黄疸 (5 0 % )、急性胆囊炎 (5 0 % )、慢性胆囊炎胆囊结石伴胆总管扩张 (35 .7% )。其中急性化脓性胆管炎、胆源性胰腺炎、急性胆囊炎胆囊结石伴阻塞性黄疸双阳性病例中各有 1例胆囊和胆总管内胆汁培养菌种不同。结论　胆石病病人不同部位胆汁内菌种大多数相同但存在差异 ,其药敏也有所不同。我们建议胆囊切除胆总管探查术 ,尤其在急性期并伴有黄疸病例中应同步培养胆囊和胆总管内胆汁 ,其对术后抗生素应用有指导作用

Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in 56 patients undergoing cholecystectomy and choledochotomy

Objective To investigate the bacteriologic characteristics of bile from gallbladder and common bile duct and antibiotic sensitivity in the patients with cholelithiasis.Methods The simultaneous bacteriologic assessment of bile from gallbladder and common bile duct and antibiotic sensitivity test was performed in 56 patients who underwent cholecystectomy and choledochotomy.Results The positive rate of bacterial culture of the bile from gallbladder and common bile duct was 100% in acute purulence cholengitis, 57.1% in acute pancreatitis, 50% in acute cholecystitis, and 35.7% in chronic cholecystitis with choledochectasia. In 3 cases the bacteria were different between the gallbladder and common bile duct.Conclusion Most of the bacteria from bile of gallbladder and common bile duct were the same. The use of antibiotics should be based on the result of drug sensitive test and the bacterio culture of the bile from gallbladder and common bile duct should be done simultaneously during cholecystectomy and choledochotomy.