Pradhan S B
Department of Pathology, Kathmandu Medical College & Teaching Hospital, Sinamangal, Nepal.
Kathmandu Univ Med J (KUMJ). 2009 Apr-Jun;7(26):125-8. doi: 10.3126/kumj.v7i2.2704.
Cholelithiasis is one of the most common digestive surgical disorders. The natural history of gallstone development is unknown. Bacteria are found in high concentration in bile and stone. It is difficult to ascertain whether bacterial infection of the bile arose before stone formation or vice versa.
MATERIALS & METHODS: Prospective study was carried out in 30 cholecystectomy specimens of patients with cholelithiasis collected from 15th January 2005 to 24th July 2005 in Department of Pathology, Kathmandu Medical College Teaching Hospital. The samples were collected in a sterile vial containing 0.5% saline. A small piece of gallbladder was taken in Blood agar and Chocolate agar media for micro anaerobic culture at 370 degrees Celsius. The growth of the organism was observed after 48 hours of incubation. Gram stain and various biochemical tests were performed for the confirmation of Helicobacter hepaticus and its sensitivity pattern was studied. Histologically Helicobacter hepaticus was demonstrated in formalin fixed tissue sections using Warthin Starry Silver stain.
A total of 76.66% cases showed growth positivity. Nitrofurantoin was found to be the most sensitive drug (95.7%) for Helicobacter hepaticus followed by Ciprofloxacin (91.3%), Cephalaxin (91.3%), Certriaxone (91.3%),Ofloxacin (82.6%), Amikacin (65.2%) and Norfloxacin (60.9%). Helicobacter hepaticus was least sensitive to Amoxycillin (57%).
From this study, it is quite apparent that Helicobacter hepaticus infection is commonly associated (76.66%) with cholelithiasis. If the patients are treated with the sensitive antibiotics regularly and the infection, that is the number one cause for the precipitation of bile leading to the formation of gallstones, can be controlled, the incidence of cholelithiasis can be reduced so that the health care expenditure related to gallbladder disease can be reduced markedly.
胆结石是最常见的消化系统外科疾病之一。胆结石形成的自然史尚不清楚。在胆汁和结石中发现细菌浓度很高。很难确定胆汁的细菌感染是在结石形成之前还是反之亦然。
于2005年1月15日至2005年7月24日在加德满都医学院教学医院病理科收集了30例胆结石患者的胆囊切除标本进行前瞻性研究。样本收集在含有0.5%盐水的无菌小瓶中。取一小片胆囊组织置于血琼脂和巧克力琼脂培养基中，于37摄氏度进行微需氧培养。孵育48小时后观察细菌生长情况。进行革兰氏染色和各种生化试验以确认肝螺杆菌，并研究其敏感性模式。在福尔马林固定的组织切片中使用沃辛-斯塔瑞银染色法显示肝螺杆菌。
总共76.66%的病例显示生长阳性。发现呋喃妥因是对肝螺杆菌最敏感的药物（95.7%），其次是环丙沙星（91.3%）、头孢氨苄（91.3%）、头孢曲松（91.3%）、氧氟沙星（82.6%）、阿米卡星（65.2%）和诺氟沙星（60.9%）。肝螺杆菌对阿莫西林最不敏感（57%）。
从这项研究中很明显可以看出，肝螺杆菌感染通常与胆结石相关（76.66%）。如果患者定期用敏感抗生素治疗，并且作为胆汁沉淀导致胆结石形成的首要原因的感染能够得到控制，那么胆结石的发病率就可以降低，从而可以显著减少与胆囊疾病相关的医疗保健费用。
