胆汁感染的病原菌分布及耐药性调查分析

目的探讨胆汁感染病原菌的分布及耐药性,为临床医师合理使用抗菌药物提供科学依据。方法对589株胆汁感染病原菌进行常规鉴定,用K-B法进行体外药物敏感试验。结果 173例患者胆汁中分离出病原菌233株,其中革兰阴性杆菌分离率为72.96%,革兰阳性杆菌分离率为24.89%,胆汁感染中除了大肠埃希菌、肺炎克雷伯菌对亚胺培南敏感率为100.00%,肠球菌属对替考拉宁、利奈唑烷敏感率为100.00%,屎肠球菌对氯霉素、万古霉素敏感率为100.00%以外,对其他抗菌药物均产生了不同程度的耐药性。结论胆汁感染病原菌对抗菌药物已产生了一定的耐药性,药敏试验结果可指导临床合理选用抗菌药物。

更昔洛韦治疗婴儿巨细胞病毒感染相关胆汁淤积性肝炎的疗效分析

目的:探讨更昔洛韦(GCV)在治疗婴儿巨细胞病毒感染相关胆汁淤积性肝炎的抗病毒疗效。方法:将155例巨细胞病毒感染相关胆汁淤积性肝炎患儿,随机分为治疗组和对照组,在基础治疗上,治疗组给予GCV抗病毒治疗,对照组未予GCV治疗,观察两组的临床疗效。结果:治疗组与对照组治疗前后肝功能、痊愈率、好转率、无效率等比较差异均无统计学意义(均P>0.05)。结论:GCV治疗婴儿巨细胞病毒感染相关性胆汁淤积性肝炎不能增加临床好转率及肝功能改善情况。

胆汁细菌性感染时血浆内毒素水平的变化

目的 :研究胆汁在不同类型的细菌感染时血浆内毒素含量的变化。方法 :胆囊切除术中取胆汁作细菌培养和涂片染色镜检。革兰氏阴性菌感染者 ( 40例 )、革兰氏阳性菌感染者 ( 40例 )和菌检阴性者 (对照组 4 0例 )共 1 2 0例 ,均在胆囊切除术前后测定血浆内毒素水平。结果 :术前革兰氏阴性菌感染组血浆内毒素水平明显高于革兰氏阳性菌感染组和对照组 (P <0 .0 1 ) ,革兰氏阳性菌感染组与对照组之间无明显差异 (P >0 .0 5) ;术后革兰氏阴性菌感染组血浆内毒素水平很快下降与术前比较有极显著差异 (P <0 .0 1 )。结论 :血浆内毒素定量测定 ,可作为判断胆汁感染轻重程度和观察治疗效果的指标。

微波原位热固化治疗肝脏肿瘤

目的 研究微波原位热固化治疗肝脏肿瘤的疗效。方法 从 1996年 10月至 1999年 4月 ,用 8导植入式微波治疗机对 3 1例肝脏肿瘤患者进行了微波原位热固化治疗 ,治疗中心温度 110℃ 12 5℃ ,治疗时间 2 6分钟。术后随访2 6例 ,随访时间 3个月 3年。结果 显效 5 4.8% ,部分显效 3 5 .5 % ,总有效率为 90 .3 %。术后平均生存期 19.7个月 ,术后 1年、3年生存率分别为 77.4%及 3 8.7%。结论 微波原位热固化治疗肝脏肿瘤具有创伤小、恢复快、患者耐受好及疗效确切的优点。特别是对无法切除的肝脏肿瘤是一种安全、有效。

熊胆粉联合西药治疗婴儿巨细胞病毒感染相关胆汁淤积性肝炎

目的:评价熊胆粉联合更昔洛韦治疗婴儿巨细胞病毒(CMV)感染相关胆汁淤积性肝炎的治疗效果。方法:将46例婴儿巨细胞病毒感染相关胆汁淤积性肝炎患儿随机分为治疗组24例与对照组22例。两组均给予更昔洛韦5 mg·kg-1,12 h/次等综合对症治疗。治疗组在此基础上加用熊胆粉0.02 g·kg-1口服,2次/d,均连用14 d,观察结果。结果:治疗组治疗前后比较血清总胆汁酸、血清总胆红素、直接胆红素、肝内胆管宽度差异有统计学意义(P<0.01),对照组治疗前后直接胆红素、胆汁酸、肝内胆管宽度无统计学意义;两组黄疸开始消退时间、黄疸完全消退时间之间差异有非常显著性意义(P<0.01)。结论:熊胆粉可以降低总胆红素和直接胆红素,降低胆汁酸水平,减轻肝功能损伤,减轻胆管扩张,促进黄疸消退。

Role for mycobacterial infection in pathogenesis of primary biliary cirrhosis?

Primary biliary cirrhosis （PBC） is a progressive cho- lestatic liver disease characterized by the immune- mediated destruction of biliary epithelial cells in small intrahepatic bile ducts. The disease is characterized by circulating antimitochondrial antibodies （AMAs） as well as disease-specific antinuclear antibodies, cholestatic liver function tests, and characteristic histological fea- tures, including granulomas. A variety of organisms are involved in granuloma formation, of which mycobacte- ria are the most commonly associated. This has led to the hypothesis that mnycobacteria may be involved in the pathogenesis of PBC, along with other infectious agents. Additionally, AMAs are found in a subgroup of patients with rnycobacterial infections, such as lep- rosy and pulmonary tuberculosis. Antibodies against species-specific mycobacterial proteins have been re- ported in patients with PBC, but it is not clear whether these antibodies are specific for the disease. In addi- tion, data in support of the involvement of the role of molecular mimicry between rnycobacterial and human mitochondrial antigens as triggers of cross-reactive im- mune responses leading to the loss of immunological tolerance, and the induction of pathological features have been published. Thus, antibodies against myco- bacterial heat shock protein appear to cross-recognize AMA-specific autoantigens, but it is not clear whether these autoantibodies are mycobacterium-species-spe- cific, and whether they are pathogenic or incidental. The view that mycobacteria are infectious triggers of PBC is intriguing, but the data provided so far are not conclusive.

Acute acalculous cholecystitis in children

Acute acalculous cholecystitis(AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses(such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.

Enteroenteroanastomosis near adjacent ileocecal valve in infants

AIM:To investigate the feasibility and the effectiveness of ileoileostomy in the region adjacent to the ileocecal valve,which can retain the ileocecal valve in infants.METHODS:This is a retrospective review of 48 patients who underwent ileoileostomy in the region adjacent to the ileocecal valve(group 1) and 34 patients who underwent ileocecal resections and ileotransversanastomosis(group 2).Patients were monitored for the time to flatus,resumption of eating,length of hospital stay after surgery,serum total bile acid,vitamin B12 and postoperative complications.RESULTS:The time to flatus,time until resumption of eating and post-operative length of hospital stay showed no statistically significant differences between the two groups.Serum total bile acid and vitamin B12were not significantly different between the two groups at post-operative day 1 and day 3,but were significantly decreased at 1 wk after operation in group 2.None of the patients died or suffered from stomal leak in these two groups.However,the incidence of diarrhea,intestinal infection,disturbance of acid-base balance and water-electrolytes in group 1 was lower than in group 2.CONCLUSION:Ileoileostomy in the region adjacent to the ileocecal valve is safe and results in fewer complications than ileotransversanastomosis in infants.

Fasciola hepatica infestation as a very rare cause of extrahepatic cholestasis

Fasciola hepatica,an endemic parasite in Turkey,is still a very rare cause of cholestasis worldwide.Through ingestion of contaminated water plants like watercress,humans can become the definitive host of this parasite.Cholestatic symptoms may be sudden but in some cases they may be preceeded by a long period of fever,eosinophilia and vague gastrointestinal symptoms.We report a woman with cholangitis symptoms of sudden onset which was proved to be due to Fasciola hepatica infestation by an endoscopic retrograde cholangiography.

肝硬化黄疸患者胆道细菌病原学分析对合理应用抗生素治疗的影响

目的探讨肝硬化黄疸患者胆道细菌病原学分析对合理应用抗生素治疗的影响。方法选取2018年6月至2021年2月汕头市第二人民医院收治的肝硬化黄疸患者178例作为研究对象,随机分为A组(n=53)、B组(n=57)和C组(n=68)。A组采用常规护肝治疗,并予以口服丁二磺酸腺苷蛋氨酸肠溶片;B组在A组治疗方案基础上给予经验性抗感染治疗;C组在A组治疗方案基础上,根据胆汁病原菌药敏试验结果给予针对性抗感染治疗。分析病原菌构成及药敏试验结果,并比较3组患者治疗前后终末期肝病模型(MELD)评分、Child-Pugh分级评分、肝功能指标和凝血功能指标。结果在C组68例患者中一共检出60株病原菌,其中革兰阴性菌38株(63.3%)、革兰阳性菌21株(35.0%)、真菌1株(1.7%)。革兰阴性菌对氨苄西林、头孢唑林、头孢曲松、氨曲南、头孢呋辛、环丙沙星、左氧氟沙星、阿莫西林等药物耐药率高,革兰阳性菌对利福平、克林霉素、青霉素、环丙沙星、红霉素、四环素、左氧氟沙星等抗菌药物的耐药率较高。治疗后,C组MELD评分、Child-Pugh分级评分低于A组、B组,差异有统计学意义(P<0.05);C组总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)低于A组、B组,凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)短于A组、B组,纤维蛋白原(FBG)高于A组、B组,差异有统计学意义(P<0.05)。结论肝硬化黄疸患者胆汁感染以大肠埃希菌、肺炎克雷伯菌、粪肠球菌为主,对常用抗生素的耐药性较高。临床根据药敏试验结果合理应用抗生素治疗可有效改善患者肝功能和凝血功能,缓解病情。