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目的探讨经ERCP取石的胆总管结石患者十二指肠液与胆汁细菌培养结果的临床分析。方法收集2012年1月-2013年12月本院107例胆总管结石患者,在择期行ERCP的术中采集十二指肠液及胆汁进行细菌培养,比较两标本培养结果之间的关系,分析细菌种类及其耐药谱。结果 107例胆总管结石患者细菌培养阳性率为31.78%(34/107),其中十二指肠液细菌培养阳性率为21.50%(23/107),胆汁细菌培养阳性率为28.97%(31/107),两者差异无统计学意义(χ2=3.50,P>0.05),且菌种分布基本一致。培养细菌以大肠埃希菌、肺炎克雷伯菌及肠球菌属为主;革兰阴性杆菌对亚胺培南、美罗培南、丁胺卡那100%敏感,肠球菌属对替考拉宁、力萘唑烷、万古霉素100%敏感,对氨苄西林、环丙沙星耐药率均低于10%。结论胆总管结石择期行ERCP患者术后胆汁细菌培养阳性主要来源于操作过程中十二指肠液的污染,十二指肠液与胆汁同时培养对术后带菌原因判断更有意义。临床应注重细菌培养及耐药性检测,合理使用抗菌药物。
Objective To investigate the clinical results of bacterial culture of duodenal juice and bile in patients with choledocholithiasis by ERCP. Methods A total of 107 patients with choledocholithiasis in our hospital from January 2012 to December 2013 were enrolled in this study. Duodenal fluid and bile juice were collected during ERCP elective surgery. The relationship between the two cultures was compared. Species and resistance spectrum. Results The positive rate of bacterial culture in 107 cases of choledocholithiasis was 31.78% (34/107). The positive rate of bacterial culture in duodenal fluid was 21.50% (23/107) and the positive rate of bile bacteria culture was 28.97% (31/107 ), No significant difference between the two (χ2 = 3.50, P> 0.05), and the distribution of bacteria is basically the same. Escherichia coli, Klebsiella pneumoniae and Enterococcus were the main pathogens in culture. Gram-negative bacilli were 100% sensitive to imipenem, meropenem and amikacin, Thiazolidine, vancomycin 100% sensitive to ampicillin, ciprofloxacin resistance rates were less than 10%. Conclusions The positive rate of postoperative bile bacterial culture in patients with choledocholithiasis for elective ERCP is mainly due to the contamination of duodenal fluid during operation. Simultaneous culturing of duodenal juice and bile makes more sense for postoperative carrier reasons. Clinical should focus on bacterial culture and drug resistance testing, rational use of antimicrobial agents.