直视微创胆囊切除术患者抗生素的应用

Application of antibiotics in patients with minimally invasive direct vision cholecystectomy

目的:探讨直视微创胆囊切除术患者抗生素应用的意义。方法:选择胆道疾病患者278例,行直视微创胆囊切除术,术中通过胆囊穿刺抽取胆汁行细菌培养,根据药敏试验结果选择应用抗生素。结果:胆汁培养:第1组,单纯结石或息肉组细菌培养阳性率2/163(1.2%);第2组,慢性结石性胆囊炎组3/78(3.8%);第3组,急性炎症组(急性结石性胆囊炎、慢性结石性胆囊炎急性发作、急性化脓性胆囊炎、急性胆管炎)21/37(56.8%)。结论:胆汁细菌培养中急性炎症组阳性率高,第1组及第2组阳性率较低,由于直视微创胆囊切除术切口小、手术时间短、对腹腔干扰小。对第1、第2组患者可术前、术后各使用一次抗生素,对第3组患者可使用5-7天。全部278例患者无1例发生切口感染、腹腔脓肿等感染性并发症。

Objective：To explore the significance in application of antibiotics in patients with minimally invasive direct vision cholecystectomy. Methods： 278 patients with minimally invasive direct vision cholecystectomy were extracted bile for germiculture by gall bladder during operation, in which the result of drag sensitive test was the evidence of choosing application of antibiotics. Results：Results of bile culture in positive bacterial culture of simple stone of polyp was 2/163 （1.2%）in the first group, of chronic calculous cholecystitis was 3/78（3.8% ） in the second group of acute cholelithiasis,chronic calculous cholecystitis acute episode,acute suppurative cholecystitis and acute cholangitis was 21/37 （56.8%） in the third group. Conclusion： Positive rate of bile bacterial culture is high in the third group and are low in the first and second group due to incision small, short operation time and less injury of minimally invasive direct vision eholecysteetomy. Antibiotics are used before and after operation in the first and second group, continuing 5 -7 days in the third group.None of 278 cases was postoperative infection, peritoneal abscess or infectious complications.