胆系感染的菌群结构分析及临床意义  

Structural analysis and clinical significance of the bacterial group in infection of the biliary system

作　　者：杨玉龙 谭文翔 付维利 刘小北 李雪驼[2] 刘波[2] 

机构地区：[1]大连市肝胆外科研究所友谊医院肝胆外科,辽宁大连116001 [2]中科院大连化学物理研究所,辽宁大连116001

出　　处：《肝胆胰外科杂志》2004年第1期26-28,31,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 :了解胆系感染的菌群结构新变化 ,为胆石的成因和发病机制的研究提供依据 ;对电穿孔治疗 (electropvrationtherapy ,EPT)术后病人的胆汁细菌学的研究 ,为该技术的可行性、科学性提供临床根据。方法 :对 5 5例确诊为胆系感染 ,对每例的胆汁、胆石进行需氧、厌氧菌培养 ,胆石分类后分别行电镜观察。结果 :胆汁和胆石培养出的细菌种类相似 ,以肠球菌属占首位 ,其次是大肠杆菌和克雷伯菌属 ,且多为两种或两种以上细菌的复合感染 ,其中胆汁复合感染率为 5 4 .3% ,胆石复合感染率为 6 6 .7%。HP的阳性率 :胆汁 :10 /5 5 (占 18.2 % ) ;胆石 :8/ 4 6 (占 17.4 % ) ;厌氧菌培养的阳性率 :胆汁 :2 0 / 5 5 (占 36 .4 % ) ;胆石 :18/ 4 6 (占 39.1% ) ;对胆色素结石进行电镜扫描观察 :均观察到有细菌存在 ,胆固醇结晶中少有细菌 ,结石核心可发现细菌 ;EPT术后 :2例阳性 (大肠杆菌 ) ,3例阴性。结论 :胆系感染病人的胆汁和胆石培养出的细菌种类相似 ,以肠球菌属占首位 ,其次是大肠杆菌和克雷伯菌属 ,且首次发现有幽门螺杆菌 (HP)的存在。电镜观察细菌存在于结石的核心和外周 ,说明细菌在胆结石的成因和发病机制中充当始动因子作用。EPT治疗后病人胆汁细菌培养结果初步说明胆道仍保持有其封闭性和屏蔽作用。Objective:To realize the structural changes of the bacterial groups of infection in the biliary system for providing proof for studying on the cause of formation and mechanism of the gallstones and to provide the clinical bases for the feasibility of this technique through the bacterial research of the patient's bile after EPT operation.Methods:Bile and calculus of each patient were cultured with oxygen and without oxygen in 55 patients diagnosed as biliary system infection. Calculi were observed with electronic microscope after calculi were classified.Results:Species of bacterium cultured from bile and gallstone was similar. Enterococcus was in the first place. Number two is E. coli and Klebesiella. Moreover,almost all biliary infections were compound infection with two kinds of bacterium or more. The compound infection rate in the bile was 54.3%,in the calculi 66.7%. HP culture positive rate of bile was 10/55(18.2%) and that of gallstone 8/46(17.4%),that of anaerobic in bile was 20/55(36.4%) and that of anaerobic in the gallstone 18/46(39.1%). Observed under the electronic microscope,bacteria existed in the all cholesterol stone,a little bacterium was seen in the cholesterol crystal,and bacteria were found in the core of the cholesterol stone. Bacterial culture was positive in 2 cases(E. coli) and negative in 3 cases after EPT operation.Conclusion:The bacterial group cultured from bile and calculi of the patients of the biliary infection is similar. The enterococcus is the primary. Number two is E,coli and Klebesiella. It is found for the first time that the helicobacter pylori(HP) exist in the bile and calculus. That bacterium exists in the core and the peripheral of the gallstone suggests that bacterium acts as an important factor in the cause of formation and mechanism of cholelith. The result of bacterial culture shows the biliary tract still remains to have blocking behavior and shield action.

关 键 词：胆系感染 胆结石 细菌 电镜扫描 电穿孔 

分 类 号：R657.42[医药卫生—外科学]