【摘要】 目的 通过对老年患者(≥65岁)内镜与术中肝管胆汁细菌培养和药敏试验的结果进行对比研究，以明确前者在指导临床应用抗菌药物的价值。方法 以感染严重评分(SSS)<30和感染评分(SS)<10作为入选条件(Psss>0.05，Pss>0.05)，分为内镜组(n=61)和手术组(n=62)，内镜组经肝管插管获取胆汁，手术组经穿刺肝管获取胆汁，立即进行细菌培养和药敏测试，对结果进行对比分析。结果 对比内镜组与手术组的阳性率(P>0.05)，革兰阴性菌除了大肠杆菌分布P>0.05，两组大肠杆菌P<0.05，革兰阳性菌分布P>0.05。革兰阴性菌药物敏感P>0.05，中度敏感P>0.05。革兰阳性菌药物敏感P>0.05，中度敏感P>0.05。革兰阴性菌中丁胺卡那与庆大霉素药物敏感对比P<0.05。建议使用对手术和内镜两组都敏感或中度敏感的抗菌药物，革兰阴性菌使用：丁胺卡那、亚胺培南、氨苄青霉素。革兰阳性菌使用：万古霉素、环丙沙星、氨苄青霉素。结论 老年胆石病患者细菌培养阳性率较高，通过内镜取材进行细菌培养可以大致反映胆管内细菌学状况，不应轻易放弃并值得推广。

    【关键词】 老年；十二指肠内镜检查；细菌学

    Bacteriology comparison study in 123 aged patients about bile from liver common bile duct both in ERCP and operation

    FENG Yu,SUN Zhu-feng,WAN Liu-hua,et al.

    Shanghai Shuguang Hospital,Shanghai 200021,China

    【Abstract】 Objective This prospective study for aged patients was performed to use antibiotics basis on the bacterio-culture of bile from liver common bile duct in ERCP,it was correct or not.Methods We made a bacterio-culture of bile of 123 patients who underwent cholecystectomy or ERCP.Based on SSS<30 (septic severity score) and SS<10 (sepsis score).Endoscopy group was 61,operation group was 62.Then we analyzed the bacteriology data.Results No statistical differences were observed between endoscopy group and operation group.Conclusion From this study,we conclude that the bacterio-culture of bile should be done in ERCP and hope to generalize it. ......