CAJ | 학술논문

目的：比较逆行胰胆管造影（ERCP）术中所获胆汁及十二指肠液细菌培养结果，前瞻性分析择期行ERCP术后胆道感染与十二指肠液污染之间的关系，并判断术前口服庆大霉素是否能降低术后胆道感染的发生率。方法选取2012年1月－2013年6月因胆总管结石择期行ERCP治疗的患者共210例，将其随机分为对照组115例与试验组95例；试验组于术前30 min口服含16 IU庆大霉素的灭菌液50 ml ，对照组于术前30 min口服不含庆大霉素的灭菌液50 m l ，对比两组灭菌效果。结果对照组患者十二指肠液培养阳性与阴性的胆汁培养阳性率分别为10．6％与76．7％，比较差异有统计学意义（ P＜0．01），试验组患者十二指肠液培养阳性与阴性的胆汁培养阳性率分别为8．6％与76．7％，比较差异有统计学意义（ P＜0．01）；口服含庆大霉素的灭菌液后，十二指肠液及胆汁培养阳性率试验组分别为14．7％及15．8％、对照组分别为26．1％及27．8％，两组比较差异有统计学意义（P＜0．05）。结论胆总管结石择期行ERCP的患者术后引起胆道细菌感染与操作过程中十二指肠液的污染有关，术前口服庆大霉素可降低感染发生率。
목적：비교역행이담관조영（ERCP）술중소획담즙급십이지장액세균배양결과，전첨성분석택기행ERCP술후담도감염여십이지장액오염지간적관계，병판단술전구복경대매소시부능강저술후담도감염적발생솔。방법선취2012년1월－2013년6월인담총관결석택기행ERCP치료적환자공210례，장기수궤분위대조조115례여시험조95례；시험조우술전30 min구복함16 IU경대매소적멸균액50 ml ，대조조우술전30 min구복불함경대매소적멸균액50 m l ，대비량조멸균효과。결과대조조환자십이지장액배양양성여음성적담즙배양양성솔분별위10．6％여76．7％，비교차이유통계학의의（ P＜0．01），시험조환자십이지장액배양양성여음성적담즙배양양성솔분별위8．6％여76．7％，비교차이유통계학의의（ P＜0．01）；구복함경대매소적멸균액후，십이지장액급담즙배양양성솔시험조분별위14．7％급15．8％、대조조분별위26．1％급27．8％，량조비교차이유통계학의의（P＜0．05）。결론담총관결석택기행ERCP적환자술후인기담도세균감염여조작과정중십이지장액적오염유관，술전구복경대매소가강저감염발생솔。
OBJECTIVE To prospectively analyze the relationship between infections of biliary tract after elective ERCP and duodenal fluid contamination by comparing the bacterial culture results of bile and duodenal fluid after ERCP ,and judge whether preoperative oral gentamicin can reduce the incidence of postoperative infections of bili‐ary tract .METHODS Totally 210 patients with choledocholithiasis receiving selective ERCP during Jan .2012 to Jun .2013 were randomly grouped into the experimental group (95 cases) and the control group (115 cases) .Pa‐tients in the experimental group received oral administration of 50 ml sterile water containing 16 IU gentamicin at 30 min before ERCP ,while the control group received oral administration of 50 ml sterile water without gentami‐cin at 30 min before ERCP .The sterile effect in the two groups was compared .RESULTS The positive rate of bile culture for patients with positive vs .negative duodenal juice culture was 10 .6% vs .76 .7% in the control group and 8 .6% vs .76 .7% in the experimental group ,the differewce was significant (P<0 .01) .After oral administra‐tion of sterile water containing gentamicin ,the positive rate for duodenal juice culture and bile culture was 14 .7%and 15 .8% in the experimental group ,26 .1% and 27 .8% in the control group ,the differenle was significant (P<0 .05) .CONCLUSION Infection of biliary tract in patients with choledocholithiasis undergoing elective ERCP is associated with duodenal juice contamination ,preoperative oral gentamicin can reduce the incidence of infections .