梗阻性黄疸行ERCP或PTCD__省略_TGD术收取胆汁行细菌培养99例_朱晓丹VIP免费

wcjd@wjgnet.com世界华人消化杂志2014年12月28日;22(36):5693-5698ISSN1009-3079(print)ISSN2219-2859(online)临床经验CLINICALPRACTICE梗阻性黄疸行ERCP或PTCD/PTGD术收取胆汁行细菌培养99例朱晓丹,陈卫刚,韩岩智,尚国臣,郑勇®■背景资料胆道梗阻所致的胆汁引流不畅是引起胆道感染的重要因素.经皮肝穿刺胆管/胆囊引流术(percutane-oustranshepaticcholangiography/gallbladderdrain-age,PTCD/PTGD)和经内镜逆行胰胆管造影(endo-scopicretrogradecholangiopancrea-tography,ERCP)作为引流胆汁的方式可快速有效的缓解临床症状,纠正胆汁淤积、反流等因素所引起的肝脏功能的损害.然而,ERCP、PTCD及PTGD亦是胆道感染的独立危险因素,不同的病因引起感染的细菌谱及不同术式细菌检出率及细菌分布可能有所不同.朱晓丹,陈卫刚,韩岩智,尚国臣,郑勇,石河子大学第一附属医院消化内科新疆维吾尔自治区石河子市832000朱晓丹,在读硕士,主要从事肝胆胰肿瘤诊治的研究.作者贡献分布:朱晓丹与郑勇对此文所作贡献均等;此课题由朱晓丹、陈卫刚、韩岩智、尚国臣及郑勇设计;技术操作由郑勇、陈卫刚、韩岩智及尚国臣操作完成;数据分析及论文写作由朱晓丹完成.通讯作者:郑勇,主任医师,832000,新疆维吾尔自治区石河子市北二路,石河子大学第一附属医院消化内科.zy2850@126.com电话:0993-2859284收稿日期:2014-08-13修回日期:2014-11-05接受日期:2014-11-12在线出版日期:2014-12-28BacterialcultureofbileharvestedfromobstructivejaundicepatientsbyERCPorPTCD/PTGDdrainage:Analysisof99casesXiao-DanZhu,Wei-GangChen,Yan-ZhiHan,Guo-ChenShang,YongZhengXiao-DanZhu,Wei-GangChen,Yan-ZhiHan,Guo-ChenShang,YongZheng,DepartmentofGastroenterol-ogy,theFirstAffiliatedHospitalofShiheziUniversity,Shi-hezi832000,XinjiangUygurAutonomousRegion,ChinaCorrespondenceto:YongZheng,ChiefPhysician,De-partmentofGastroenterology,theFirstAffiliatedHospitalofShiheziUniversity,BeierRoad,Shihezi832000,Xinji-angUygurAutonomousRegion,China.zy2850@126.comReceived:2014-08-13Revised:2014-11-05Accepted:2014-11-12Publishedonline:2014-12-28AbstractAIM:Toassessthedistributionandcharacteristicsofbilepathogenicbacteriainobstructivejaundicepatientswhoreceivedendoscopicretrogradecholangiopancreatography(ERCP)orpercutane-oustranshepaticcholangiography/gallbladderdrainage(PTCD/PTGD)andanalyzetheisolatedbilebacteria,inordertoguidethereasonableandindividualizeduseofantibiotics.METHODS:Aretrospectiveanalysiswasper-formedoftheclinicaldatafor90patientswithobstructivejaundicewhoreceivedERCPorPTCD/PTGDdrainageattheFirstAffiliatedHospitalofShiheziUniversityfromJanuary2008toSeptember2013.Therelationshipbe-tweenbacterialspectrumandthenatureofbiliaryobstructionortheselectionofdrainagemethodswasanalyzed.RESULTS:Atotalof99bilesampleswereharvestedfrom90patients(including55chole-lithiasispatientsand35malignancypatients),ofwhich32wereobtainedbyERCPand67byPTCD/PTGD.Bacterialgrowthwasfoundinthebiledrainageof64(64.6%)patients.Atotalof73strainswerecultured,including63(86.3%)gram-negativestrainsand10(13.7%)gram-positivestrains.Therateofbacterialdetectionwas56.8%inmalignantobstructionpatientsand70.9%inchololithiasispatients(P>0.05).InpatientswhoreceivedERCPorPTCD/PTGDdrainageforthefirsttime,therateofbacterialdetectionwas78.1%and56.9%,respectively,whichshowedasignificantdifference(P<0.05).Therateofbacterialdetectiondidnotdiffersig-nificantlybetweenbilesamples(fromthosewhohadoneormoreoperations)collectedbyERCPandthosebyPTCD/PTGD(P>0.05).CONCLUSION:Gram-negativebacteriaremainthecommonestpathogensinpatientswithob-structivejaundice.ThetopthreepathogenicbacteriaareEscherichiacoli,Ente...