肝内胆管结石患者胆汁的细菌谱及临床意义

目的探讨肝内胆管结石患者胆汁细菌谱以及其对肝切除术后感染并发症发生的关系。方法回顾性分析我院2007年8月至2009年3月有完整胆汁细菌培养结果并行择期肝切除术的肝内胆管结石患者162例，分析胆汁中细菌谱，通过单因素和多因素分析引起术后感染并发症的危险因素。结果肝内胆管结石患者胆汁细菌培养阳性率为77．2％，革兰阴性菌占61．7％。前3位菌属分别是大肠埃希杆菌属（30．5％）、粪肠球菌属（29．8％）和单胞菌属（14．9％）。本组无手术死亡，感染并发症发生率为29．0％，最常见的并发症为切口感染、胆漏和腹腔感染。Logistic多因素分析表明胆汁细菌培养阳性（P=0．026，OR=8．560）和手术时间（P=0．04，OR=1．007）是引起肝内胆管结石肝切除术后感染并发症发生的独立危险因素。结论肝内胆管结石患者胆汁细菌种类繁多，以大肠埃希杆菌属、粪肠球菌属和单胞菌属为主，胆汁细菌培养阳性是引起术后感染并发症发生的危险因素。

Bacterial spectrum of bile in patients with intrahepatic stone and its clinical significance

Objective To evaluate the bacterial spectrum of bile in patients with intrahepatic stone and its surgical significance associated with postoperative septic complications. Methods One hundred and sixly-two consecutive intrahepatic stone patients who had detailed bacterial culture data and underwent liver resection from August 2008 to March 2009 were reviewed retrospectively. The bacterial spectrum of bile and the postoperative septic complications were evaluated. And the risk factors related to postoperative septic complication were identified by Logistic regression. Results The bile bacterial culture positive rate was 77.2%. The most three predominant bacteria flora were Escherichia Coli, Enterococcus feacalis, Pseudomonas spp. There was no surgical mortality and the surgical septic morbidity was 29.0%. Wound infection, bile leak and peritoneal infection were the three most common postoperative septic complications. Bile bacterial culture positive and operating time were the independent risk factors linked to postoperative septic complication. Conclusions Escherichia Coli is the predominant bacteria of bile in intrahepatic stone patients. Bile bacterial culture positive is one of the independent risk factors associated with postoperative septic complications.