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題 名 | Bacteria and Antibiotics in Biliary Tract Surgery=膽道手術的細菌學及抗生素 |
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作 者 | 李威傑; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 25:3 民81.05-06 |
頁 次 | 頁1173-1178 |
分類號 | 416.247 |
關鍵詞 | 膽道手術; 細菌學; 抗生素; |
語 文 | 英文(English) |
中文摘要 | 為了瞭解膽道手術中合併膽道感染與手術併發症的闋係,以及抗生素使用的效果。我們針對1987至1990年在本院外科接受膽道手術的143例病患加以研究。其中98例(68.8%)合併膽道感染而呈膽汁培養陽性。手術併發症有43例(30.1%),併發症的發生在膽道感染的病人(40.0%)較無感染的為高(8.9%)(P<0.05)。在細菌學的檢驗上,多重感染很常見,平均每一個檢體可檢出2.3株菌種。其中腸內球菌(Enterococcus)是最常見的菌種,54%的培養中可出現;其次為大腸桿菌(E Coli)及綠膿桿菌(Pseudomonas)培養率分別為46%及39%。百分之12.3的培養中有厭氧菌,以腸桿菌(Bacteroid)為主。如以手術前後所使用之抗生素加以比較,使用第1代,第2代及第3代頭孢子類抗生素病人的手術併發症分別為37.7%,22.7%及31.8%,並無統計學上之意義。如以細菌學上之抗生素敏感試驗研究,所使用的抗生素效力能完全覆蓋培養出的菌種(完全有效者)情況對僅部份有效之情況有明顯的低手術合併症(16.6%比上85.3%)(p值<0.001) 因此在膽道手術前,為了要選擇適當的抗生素以覆蓋常見之膽道感染情況。應選擇能覆蓋腸內球菌,格蘭氏陰性之腸內菌,特別是綠膿桿菌及大腸桿菌的抗生素。同時在嚴重感染的病患,也要考慮厭氧菌感染之可能。 |
英文摘要 | In order to understand the relationship between surgical complication and cholangitis in biliary surgery and the effect of antibiotics used, we conduct a retrospective study over biliary tract surgery in NTUH from 1987 to 1990. In 143 biliary tract surgeries, positive bile culture was found in 98 cases (68.8%). There were 43 septic related complications (30.1%) in these operations. The complication rate was higher in the positive bile culture group (40.0%) than in the negative group (8.9%). In microbiologic study, polymicrobial infection was the rule. On average, there were 2.3 species grown from a specimen. Enterococcus became the most common species with 54% culture rate. E. Coli and Pseudomonas were found with 46% and 39% culture rate. Unaerobic species, mainly Bacteroides, were cultured positively in 12.3% patients. In comparision of the various antibiotics used in the perioperative period, the complication rate for 1st, 2nd and 3rd generation of cephalosporins were 37.7%, 22.7% and 31.8% in each without statistically significance. However, if the bacteria could be fully covered by the antibiotics used in perioperatively, the surgical complication rate was 16.9%. If not, the complication rate was 85.3% (p<0.001). For good coverage of the cholangitis before biliary tract surgery, proper antibiotic chosen should have potence for G(+) Enterococcus, G(-) bacilli, especially Pseudomonas and E.coli, and unaerobic species, especially Bacterioids. |
本系統中英文摘要資訊取自各篇刊載內容。