内镜与手术中肝总管胆汁细菌培养对比再探究

目的通过对内镜与术中肝总管胆汁细菌培养和药敏试验的结果进行对比研究，以明确前者在指导临床应用抗茵药物中的价值。方法以感染严重评分（SSS）〈30和感染评分（SS）〈10作为入选条件（Psss〉0．05，Pss〉0．05），分为内镜组（n=61）和手术组（n=62），内镜组经肝总管插管获取胆汁，手术组经穿刺肝总管获取胆汁，立即进行细菌培养和药敏测试，对结果进行对比分析。结果对比内镜组与手术组的阳性率，差异无显著性意义，两组中细茵药敏试验也大致相同。结论通过内镜取材进行细菌培养可以大致反映肝总管内细菌学状况，不应轻易放弃并值得推广。同时建议使用对手术和内镜两组都敏感或中度敏感的抗菌药物，革兰阴性茵使用丁安卡那、亚胺培南、氨卞青霉素，革兰阳性茵使用万古霉素、环丙氟哌酸、氨卞青霉素。

Comparative re-study on the bacterial culture of bile from the common hepatic duct in ERCP and operation

Objective A comparative re-study on the bacterial culture of bile from the common hepatic duct in ERCP and operation, and on the result of drug sensitivity test to make clear the former value to guide the clinical application of the antimicrobial drugs.Methods One hundred and twenty-three patients undergone cholecystectomy or ERCP were divided into endoscope group (n=61) and operation group (n=62), if SSS (septic severity score) <30 and SS (sepsis score) >10 were regarded as a choson condition. In the endoscope group, bile was got from the common hepatic duct via an inserted catheter, whereas in the operation group, bile was adopted from the common hepatic duct through paracentesis. Bacteria in bile were cultured and drug sensitivity test was carried out at once. The results of both groups were analyzed comparatively.Results The positive rates in both groups were P>0.05. There was no statistical difference between both groups. The drug sensitivity test of bacteria in both groups was roughly the same.Conclusion The bacterial culture got through the endoscope could roughly reflect the bacteriological situation in the common hepatic duct. It should not be readily abandoned and should be worth spreading. It is suggested at the same time to use the sensitive or moderate sensitive antimicrobial drugs in endoscope group or in operation one. Amikacin, Imipenen and Ampicillin can be used for Gram negative bacteria. Vancomycin, Ciprofloxacin and Ampicillin can be used for Gram positive bacteria.