胆汁培养用于判断择期ERCP术后使用抗生素的价值

Antibiotics use after elective ERCP judged by bile quantitative culture

目的通过多次胆汁培养结果分析胆总管结石患者择期行经内镜逆行性胰胆管造影(ERCP)术后是否需要使用抗生素。方法胆总管结石需行ERCP术取石患者225例,随机分为实验组(115例)与对照组(110例)。实验组于术后半小时起使用广谱抗生素,对照组不使用抗生素。分别于ERCP术后半小时、术后第1天、术后第2天自鼻胆管内抽取胆汁送细菌培养。结果本研究患者ERCP术后均未发生胆管炎。术后半小时实验组胆汁培养阳性率及菌落计数与对照组比较均无统计学差异(均P>0.05),术后第1天、第2天的胆汁培养阳性率及菌落计数较对照组同时段均明显下降(均P<0.05)。实验组术后第1天胆汁培养阳性率(18.3%)及菌落计数[(4865±124)CFU/ml]较术后半小时胆汁培养阳性率(24.3%)及菌落计数[(5 376±212)CFU/ml]均明显下降(均P<0.05),术后第2天胆汁培养阳性率为16.5%,胆汁培养菌落计数为[(4795±158)CFU/ml],与术后第1天比较均无统计学差异(均P>0.05)。对照组术后半小时、第1天及第2天胆汁培养阳性率、茵落计数比较均无统计学差异(均P>0.05)。结论 ERCP术后胆管炎的发生率低,但胆汁培养阳性率较高,使用抗生素可降低胆汁培养阳性率,从而有可能降低结石的复发率,但其使用时间以24h为宜,进一步延长用药时间,其抗茵效果增强不明显。

Objective To assess the antibiotics use after elective ERCP judged by multiple bile culture. Methods Two hundred and twenty five patients with choledocholithiasis undergoing endoscopic retrograde choleopancreagraphy （ERCP） to remove gall stones were randomly grouped into study group （n=115） and control group （n=110）. Patients in study group received antibiotics 30min after ERCP and those in control group had no special treatment. Results Postoperative cholangitis was not observed in both groups after ERCP. There were no significant differences in positive rate of bile culture and bile colony counts 30min after ERCP between two group （P 〉0.05）. The positive rate bile culture and colony counts in study group were lower than those of control group at the first and second day after ERCP （P〈0.05）. The positive rate bile culture and colony counts in study group at first day after ERCP were significantly lower than those at 30min after ERCP （ 18.3% vs 24.3%; 4865 ±124CFU/ml vs 736 ± 212CFU/ml, P〈0.05 ）. There were no statistical significance in results of study group between first day and second day after ERCP （P 〉0.05）. There were no statistical significances among these results at 30min, first and second day after ERCP in the control group （P 〉0.05）. Conclusion The positive rate of bile culture after ERCP is high; antibiotics use can reduce the amount of bacteria in bile, and may reduce the recurrence rate of choledocholithiasis.