经内镜下逆行胰胆管造影术治疗急性梗阻性化脓性胆管炎患者疗效及感染病原菌调查*

目的 研究经内镜逆行胰胆管造影术（ERCP）治疗急性梗阻性化脓性胆管炎（AOSC）患者的疗效及感染病原菌特征。方法 2016年11月~2018年11月我院收治的160例AOSC患者均接受ERCP治疗。在ERCP治疗过程中抽取胆汁行细菌培养,采用纸片扩散法检测细菌对各种抗菌药物的敏感性。结果 在160例AOSC患者中,插管成功148例（92.5%）;术后3 d,有效引流者血清总胆红素为（60.2±43.3） μmol/L,显著低于术前（110.1±53.0） μmol/L,P<0.05）],中性粒细胞百分比为（60.2±5.6） %,显著低于术前（78.4±12.4） %,P<0.05];13例患者症状缓解不明显,经再次内镜或药物或介入治疗后痊愈,未出现穿孔、出血等并发症或死亡;148例完成手术治疗的患者胆汁细菌培养阳性98例（66.2%）,检出病原菌130株,其中革兰阴性杆菌占66.2%,革兰阳性球菌占33.8%,以屎肠球菌、粪肠球菌、肺炎克雷伯菌、铜绿假单胞菌为主,其中大肠埃希菌所占比例最高,占33.1%;除革兰阳性球菌对万古霉素和亚胺培南100.0%敏感、革兰阴性杆菌对亚胺培南100.0%敏感外,其他病原菌对抗菌药物均呈不同程度的耐药性。结论 采取ERCP治疗AOSC患者临床疗效确切,参照胆汁细菌培养结果合理使用抗菌药物能提高抗菌效率,减少耐药性,提高临床治疗疗效。

Efficacy of endoscopic retrograde cholangiopancreatography for the treatment of patients with acute obstructive suppurative cholangitis

Objective The aim of this study was to investigate the efficacyof endoscopic retrograde cholangiopancreatography （ERCP） in treatment of patients with acute obstructive suppurative cholangitis （AOSC）. Methods 160 patients with AOSC were enrolled in our hospital between November 2016 and November 2018,and undergone ERCP. The patients' bile was extracted for bacterial culture and drug sensitivity measurement. The sensitivity of bacteria to various antimicrobial agents was detected by paper diffusion method. Results Out of 160 patients with AOSC,the success rate of general intubation was 92.5%;total serum bilirubin level was（60.2±43.3） μmol/L 3 days after effective drainage,which was significantly lower than （110.1±53.0） μmol/L,P<0.05] before operation,and the percentage of neutrophils was（60.2±5.6） %,significantly lower than（78.4±12.4）%,P<0.05] before operation;the clinical symptoms were not obviously alleviated in 13 patients and all of them cured after re-endoscopy or drug treatment and interventional therapy;no death,perforation,bleeding and other complications occurred;among 148 patients completing the surgical treatment,the positive rate of bile culture was 66.2%,130 strains of pathogenic bacteria were detected and the gram-negative bacilli faecalis,accounted for 66.2% and gram-positive cocci accounted for 33.8%;Enterococcus faecalis,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main ones,among which Escherichia coli accounted for 33.1%;except for Gram-positive cocci were 100.0% sensitive to vancomycin and imipenem and Gram-negative bacilli were 100.0% sensitive to imipenem,the other bacteria showed different degrees of resistance to antibiotics. Conclusion ERCP is effective in dealing with patients with AOSC,and the appropriate administration of antibiotics base on the results of bile culture might improveefficacy and prevent drug resistance in clinical practice.