ERCP治疗急性化脓性胆管炎的疗效分析

Efficacy of ERCP in the Treatment of Acute Suppurative Cholangitis

目的研究内镜逆行胰胆管造影(endoscopic retrograde cholangiopancieatography,ERCP)治疗急性化脓性胆管炎(acute suppurative cholangitis,ASC)的疗效、胆汁培养结果及药敏敏感情况。方法选取2018年8月-2021年3月就诊于包头医学院第二附属医院消化内科诊断为急性化脓性胆管炎并行ERCP治疗的69例患者资料,所有患者均留取胆汁培养,并行药敏病原菌及药敏分析。结果69例患者中行内镜下鼻胆管引流(endoscopic nasobiliary drainage,ENBD)者47例,行支架置入者3例,行取石+ENBD者19例,所有患者术后临床症状改善,TBIL、DBIL、GGT、WBC、中性粒细胞、C反应蛋白、PCT较术前明显下降(P<0.05);69例患者共培养出细菌总数80株,革兰阴性菌63株(78.75%),居前2位的分别为大肠埃希菌34株(53.97%),肺炎克雷伯菌15株(23.81%);革兰阳性菌14株(17.50%),居于首位的为屎肠球菌(42.86%);真菌为3例(3.75%)。革兰阴性菌对美罗培南、亚胺培南、哌拉西林/他唑巴坦敏感率高,对莫西沙星、左氧氟沙星耐药率高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁敏感率高,对红霉素、氨苄西林、环丙沙星耐药率高;结论ERCP能有效解除胆道梗阻,迅速并安全地改善临床症状;而且在治疗过程中能有效获得胆汁标本,经过胆汁培养药敏结果,指导抗生素的应用,能够更好指导临床治疗。

Objective To study the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of acute suppurative cholangitis,the efficacy,bile culture results and drug sensitivity of acute suppurative cholangitis(ASC).Methods The data of 69 patients diagnosed as acute suppurative cholangitis and treated with ERCP in the Department of Gastroenterology of the Second Affiliated Hospital of Baotou Medical College from August 2018 to March 2021 were selected.Bile culture was taken from all patients,and drug sensitive pathogens and drug sensitivity were analyzed.Results Among the 69 patients,47 underwent ENBD,3 underwent stent implantation and 19 underwent stone removal+ENBD.The clinical symptoms of all patients were improved after operation,and TBIL,DBIL,GGT,WBC,neutrophils,C-reactive protein and PCT decreased significantly compared with those before operation(P<0.05);a total of 80 strains of bacteria were cultured in 69 patients,including 63 strains of Gram-negative bacteria(78.75%),34 strains of Escherichia coli(53.97%)and 15 strains of Klebsiella pneumoniae(23.81%);there were 14 strains of Gram-positive bacteria(17.5%),and the first was Enterococcus faecium(42.86%);Fungi were found in 3 cases(3.75%).Gram negative bacteria had high sensitivity to meropenem,imipenem and piperacillin/tazobactam,and high resistance to moxifloxacin and levofloxacin;Gram positive bacteria had high sensitivity to vancomycin,linezolid and teicoplanin,and high resistance to erythromycin,ampicillin and ciprofloxacin.Conclusion ERCP can effectively relieve biliary obstruction and improve clinical symptoms quickly and safely.Moreover,bile samples can be effectively obtained in the process of treatment.After bile culture,drug sensitivity results can guide the application of antibiotics and better guide clinical treatment.