ERCP在胆总管结石患者胆汁细菌学研究中的价值

Clinical significance of endoscopic retrograde cholangiopancreatography for bacteriological study of bile in patients with choledocholithiasis

目的:探讨ERCP法取材进行胆汁细菌学研究的可靠性,并初步了解兰州地区胆总管结石患者的胆汁中细菌种类及药敏情况.方法:对36例胆总管结石患者及11例非结石胆道狭窄患者行ERCP检查,用导管取胆汁行细菌培养及药敏试验.结果:胆总管结石组中25例(69.4%)检出29株细菌,革兰氏阴性菌23株(79.3%),大肠埃希氏菌14株,克雷伯氏菌5株及铜绿假单胞菌3株,主要敏感抗生素为亚胺培南(23/23,100%),头孢他啶(21/23,91.3%),头孢吡肟(18/23,78.3%);革兰氏阳性茵6株(20.7%),主要敏感抗生素为环丙沙星(6/6,100%),万古霉素(6/6,100%)及左氧氟沙星(4/6,66.7%);非结石胆道狭窄患者11例胆汁标本有1例(9.1%)检出细菌,两组有显著差别(P<0.05).结论:ERCP法取胆汁进行细菌学研究是简便、可靠的方法.多数胆总管结石患者胆汁中存在革兰氏阴性菌,以大肠埃希氏菌为主,克雷伯氏菌、铜绿假单胞菌次之,亚胺培南及头孢他啶为其主要敏感抗生素.

AIM： To discuss the reliability of endoscopic retrograde cholangiopancreatography （ERCP） in a bacteriological study of cholendochal bile and to study the bacterial category and antibiotic susceptibility in bile of choledocholithiasis patients in the Lanzhou area. METHODS： Bile was aspirated by ERCP in 36 choledocholithiasis patients and 11 non-stone control patients to assess bacterial category and antibiotic susceptibility. RESULTS： Twenty-nine strains of bacteria were found in 25 （69.4%） of the choledocholithiasis patients and 1 （9.1%） patient in the non-stone control group. Twenty-three of the 29 strains （79.3%） were gram-negative, including Escherichia coli （14）, Klebsiella pneumoniae （5） and aeruginosum （3）. Six strains were Gram-positive （20.7%）. With respect to antibiotics, gram-negative bacilli were sensitive to imipenem （23/23, 100%）, ceftazidime （21/23, 91.3%）, and cefepime （18/23, 78.3%）, but resistant to ampicillin （23/23, 100%）, ciprofloxacin （16/23, 69.6%） and gatifloxacin （15/23, 65.2%）. Gram-positive bacteria were sensitive to ciprofloxacin （6/6, 100%）, vancomy- cin （6/6, 100%） and levofloxacin （4/6, 66.7%）. CONCLUSION： ERCP is an easy, reliable meth- od to obtain bile for bacteriological study. Gramnegative bacilli （mainly Escherichia coli, Klebsiella pneumoniae and aeruginosum） exist in the bile of most choledocholithiasis patients in the Lanzhou area. Imipenem and ceftazidime were the most effective antibiotics.