Search

肝内外胆管结石并发慢性胰腺炎和十二指肠乳头癌1例报告

快速康复法在胆道结石患者术后早期进食中的运用及效果

目的　探讨快速康复对胆道结石（除单纯胆囊结石外） 患者术后早期进食的安全性和可行性。 方法　将2010年12月－2011年3月86例行胆道结石摘除术患者纳入对照组，术后按照常规专科护理待患者肛门排气后指导进食；将2011年4月－6月77例行胆道结石摘除术患者纳入观察组，指导患者术后早期进食。观察两组患者术后肠鸣音恢复正常的时间，肛门排气时间的差异；比较两组患者发生恶心、呕吐、腹胀等并发症的差异；观察两组术后住院天数及术后输液总量的差异。 结果　与对照组相比，观察组患者肠鸣音恢复正常时间、肛门排气时间均提前，术后总输入液量减少、住院天数缩短，两组比较差异有统计学意义（P＜0.05）；两组术后发生恶心、呕吐等并发症的差异无统计学意义（P＞0.05）。 结论　胆道结石患者术后早期进食安全可行、效果好，有利于患者的早期康复。

Analysis of bile bacterial spectrum and drug resistance in different biliary diseases

Objective To clarify the bacterial spectrum and drug resistance of different biliary diseases through bile culture results. Methods Patients who underwent surgical treatment and retained bile for cultivation at the Chinese PLA General Hospital between January 2015 and December 2016 were retrospectively collected. Clinical data such as bile bacterial culture and antibiotic sensitivity results, surgical reasons, and perioperative complications were recorded. Results A total of 272 patients were included, including 142 males and 130 females, aged (53.4 ± 14.1) years old. Intrahepatic and extrahepatic bile duct stones were the most common surgical cause, accounting for 32.4%. The positive rate of bile culture in benign diseases was 78.7%, which was higher than that in malignant diseases (48.5%). The infection related complications (30.0% vs. 6.7%), bile leakage rate (20.8% vs. 6.7%), and poor wound healing rate (24.0% vs. 0.0%) in the bile culture positive group were higher than those in the bile bacteria culture negative group (P<0.05). Among 183 patients with positive bile bacterial culture, a total of 294 strains of pathogenic bacteria were detected. There were 96 patients with single bacterial infection, 66 patients with two bacterial infections simultaneously, 18 patients with three bacterial infections, and 3 patients with four or more bacterial infections. Escherichia coli was the most common bacterium, accounting for 17.0%. There were differences in the positive rate of bile culture among patients with different etiologies (P<0.05). There were significant differences in the sensitivity rate of Enterococcus faecalis and Enterococcus faecalis for many antibacterial drugs. Conclusions There are differences in the positive rate of bacterial culture in the biliary tract of patients with different etiologies, and there is a possibility of mixed infection. It is necessary to select appropriate antibiotics for empirical treatment based on different etiologies. The use of antibiotics should be changed in a timely manner based on the results of bile culture.