發(fā)布時(shí)間：2018-06-30 18:32

  本文選題：膽總管結(jié)石 + ERCP��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：了解膽總管結(jié)石患者膽汁的菌群分布情況,探討影響膽汁細(xì)菌培養(yǎng)陽性率的相關(guān)因素。 方法：回顧性分析本院2007年1月至2014年2月期間111例膽總管結(jié)石患者經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)(ERCP)獲取膽汁的病原菌培養(yǎng)結(jié)果,并分析影響膽汁細(xì)菌培養(yǎng)陽性率的相關(guān)因素。 結(jié)果：111例膽總管結(jié)石患者膽汁病原菌培養(yǎng)陽性84例,陽性率為75.7%,共培養(yǎng)出85株病原菌,其中革蘭陰性菌72株(占84.7%),革蘭陽性菌12株(占14.1%),真菌1株(占1.’2%)。病原菌主要為埃希菌屬(占62.4%),克雷伯菌屬(占14.1%)。膽總管結(jié)石伴膽管炎患者膽汁病原菌培養(yǎng)陽性率81.18%,明顯高于單純膽總管結(jié)石的61.8%(P0.05)；多發(fā)結(jié)石患者膽汁病原菌培養(yǎng)陽性率為86.8%,明顯高于單發(fā)結(jié)石組的65.5%(P0.05)；膽總管直徑≥1.2cm患者膽汁病原菌培養(yǎng)陽性率為84.0%,明顯高于1.2cm組的58.3%(P0.05)。膽汁培養(yǎng)病原菌陽性率在性別、年齡、術(shù)前是否使用抗生素、結(jié)石是否為泥沙樣、既往是否有膽道手術(shù)史、既往是否有ERCP史、是否合并十二指腸乳頭旁憩室均未見顯著統(tǒng)計(jì)學(xué)差異(P0.05)。多因.素Logistic回歸分析示膽總管結(jié)石伴膽管炎(P=0.026,OR=3.056)、多發(fā)結(jié)石(《=0.033,OR=3.006)、膽總管直徑≥1.2cm (P=0.010,OR=3.589)均是膽汁病原菌培養(yǎng)陽性的危險(xiǎn)因素。 結(jié)論：膽總管結(jié)石患者膽汁病原菌以埃希菌屬、克雷伯菌屬為主。伴膽管炎、多發(fā)結(jié)石、膽總管直徑≥1.2cm是膽汁病原菌培養(yǎng)陽性的高危因素。ERCP術(shù)前是否使用抗生素與膽汁病原菌培養(yǎng)陽性率無關(guān)。
[Abstract]:Objective: to investigate the distribution of bacteria in bile of patients with choledocholithiasis and to explore the factors influencing the positive rate of bile culture. Methods: the results of bacterial culture in 111 patients with choledocholithiasis obtained by endoscopic retrograde cholangiopancreatography (ERCP) from January 2007 to February 2014 were retrospectively analyzed. Results 84 of 111 cases of choledocholithiasis were positive, the positive rate was 75.7%. A total of 85 strains of pathogenic bacteria were cultured, of which 72 were Gram-negative bacteria (84.7%), 12 Gram-positive bacteria (14.1%) and 1 fungus (1.42%). The main pathogens were Escherichia coli (62.4%) and Klebsiella (14.1%). The positive rate of bile pathogenic bacteria culture in patients with choledocholithiasis was 81.18, which was significantly higher than that in simple choledocholithiasis (61.8%) (P0.05), the positive rate of bile pathogenic bacteria culture in patients with multiple stones was 86.8%, which was significantly higher than that in single calculi group (65.5%) (P0.05). The positive rate of bile pathogen culture in patients with common bile duct diameter 鈮，

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