Herzog Torsten, Belyaev Orlin, Muller Christophe A, Mittelkotter Ulrich, Seelig Matthias H, Weyhe Dirk, Felderbauer Peter, Schlottmann Renate, Schrader Henning, Schmidt Wolfgang E, Uhl Waldemar
Department of Surgery, St Josef Hospital, Ruhr-University Bochum, School of Medicine, Bochum, Germany.
J Clin Gastroenterol. 2009 May-Jun;43(5):457-62. doi: 10.1097/MCG.0b013e318186b19b.
A prospective analysis of intraoperative bile duct cultures in patients undergoing surgery for both, malignant or benign periampullary diseases at the Department of Surgery, St Josef Hospital, Bochum, Germany, during a period of 18 months, between January 2004 and June 2005.
The goals of the presented study were to investigate the effects of preoperative bile duct stenting on intraoperative bile duct cultures and postoperative outcome in patients undergoing pancreatic surgery.
In pancreatic surgery, bile duct stenting is often aimed at improving postoperative outcome. As implantation of xenograft material in the main bile duct facilitates bacterial contamination and cholangitis, a critical evaluation of stenting is mandatory.
In all patients with a hepaticojejunostomy (n=80), a bile duct culture was collected during the operation. All patients received antibiotic prophylaxis perioperatively and a retrograde flushing of bile ducts with warm saline after bile duct resection. Fifty-one percent (41/80) patients had biliary drainage before surgery, whereas 49% (39/80) were operated without preoperative draining procedures.
After bile duct stenting, 98% of patients had a positive bile culture, whereas only 21% of infected bile was seen in patients without drainage (P<0.001). Despite infected bile, only 2% stented patients developed acute cholangitis postoperatively, versus 13% patients in the group without stent (P=0.231). After stenting, major complications occurred in 12%, versus 8% in patients without stent (P=0.817).
Preoperative biliary drainage leads to an almost 100% bacterial contamination of bile ducts. With hospital-adjusted antibiotic prophylaxis and retrograde flushing of bile ducts, the postoperative rate of acute cholangitis and morbidity is not elevated. A critical evaluation of benefits from preoperative biliary drainage for each patient is necessary.
对2004年1月至2005年6月期间在德国波鸿圣约瑟夫医院外科接受手术治疗的壶腹周围恶性或良性疾病患者的术中胆管培养进行前瞻性分析，为期18个月。
本研究的目的是调查术前胆管支架置入对胰腺手术患者术中胆管培养及术后结局的影响。
在胰腺手术中，胆管支架置入通常旨在改善术后结局。由于异种移植材料植入胆总管会促进细菌污染和胆管炎，因此对支架置入进行严格评估是必要的。
在所有行肝空肠吻合术的患者（n = 80）中，术中采集胆管培养样本。所有患者围手术期均接受抗生素预防，并在胆管切除术后用温盐水逆行冲洗胆管。51%（41/80）的患者术前有胆汁引流，而49%（39/80）的患者未进行术前引流程序即接受手术。
胆管支架置入后，98%的患者胆汁培养呈阳性，而未进行引流的患者中仅有21%的胆汁感染（P < 0.001）。尽管胆汁感染，但支架置入患者术后仅2%发生急性胆管炎，而未置入支架组为13%（P = 0.231）。支架置入后，主要并发症发生率为12%，未置入支架患者为8%（P = 0.817）。
术前胆汁引流导致胆管细菌污染率几乎达100%。通过医院调整的抗生素预防和胆管逆行冲洗，术后急性胆管炎和发病率并未升高。对每位患者术前胆汁引流的益处进行严格评估是必要的。
