Csendes A, Burdiles P, Maluenda F, Diaz J C, Csendes P, Mitru N
Department of Surgery, Gastrointestinal Unit, University Hospital, Santiago, Chile.
Arch Surg. 1996 Apr;131(4):389-94. doi: 10.1001/archsurg.1996.01430160047008.
To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings.
A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures.
Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile.
In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.
确定胆囊和胆总管胆汁中细菌的同时患病率，并确定存在的结石数量对细菌学检查结果的影响。
对467名受试者进行了一项前瞻性研究，将其分为七组：42名胆道正常的对照受试者、221名有症状胆结石疾病患者、12名胆囊积水患者、52名急性胆囊炎患者、67名无胆管炎的胆总管结石患者、49名胆总管结石并急性胆管炎患者以及24名既往有胆囊切除术且有胆总管结石的患者。除对照组外，同时采集胆囊和胆总管的胆汁样本进行需氧和厌氧培养。
对照受试者的胆囊胆汁中无细菌。胆结石、急性胆囊炎和胆囊积水患者的胆囊和胆总管培养阳性率相似，范围为22%至46%，但无胆管炎的胆总管结石患者的阳性率显著更高（58.2%）。胆管炎患者或既往有胆囊切除术的患者胆总管胆汁培养阳性率较高（93%至100%）。年龄大于60岁对胆汁培养阳性率有显著影响。胆囊或胆总管中的结石数量与培养阳性百分比之间无关联。在98%的患者中，从胆囊和胆总管胆汁中分离出相同的细菌。
在正常受试者中，胆道无细菌。在胆总管结石患者中，根据疾病严重程度，培养阳性率逐渐升高。年龄有重要影响，但性别和胆总管结石数量对培养阳性无影响。
