Bile infection contributes to intrahepatic calculi formation after excision of choledochal cysts
Bile infection contributes to intrahepatic calculi formation after excision of choledochal cysts
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DOI：
10.1007/s00383-004-1253-0
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发表时间：
2005-01-01
影响因子：
1.8
通讯作者：
Ogura, Y
中科院分区：
文献类型：
--
作者：
Kaneko, K;Ando, H;Ogura, Y
肝内结石合并胆总管囊肿的患者占7 - 8%。虽然先天性狭窄和肝内胆管扩张被认为是结石形成的原因，但肝内结石通常在囊肿切除后形成。在这项研究中，胆总管囊肿患者的胆汁标本进行细菌培养。结果进行了回顾性分析，在以下几组：一期切除组，包括97例患者接受囊肿切除术作为一个初步的治疗（平均年龄5.0岁），内引流组，包括13名在囊肿切除术时曾行囊肿-肠造口术的患者（平均年龄20.2岁）;肝内胆管结石组，包括12例术后肝内胆管结石患者（平均年龄24.2岁）。内引流组10例（76.9%）胆汁中有细菌，肝内胆管结石组全部（100%）胆汁中有细菌，而一期切除组仅17例（17.5%）有细菌（P< 0.01）。革兰氏阴性肠杆菌如大肠埃希菌和克雷伯氏菌属的多种微生物感染在内引流和肝内胆管结石组中占主导地位，而在原发性切除组中发现非肠道细菌。胆总管囊肿切除术后，胆肠吻合口的胆汁感染可能在肝内结石形成中起重要作用。
Intrahepatic calculi complicate choledochal cysts in 7 - 8% of patients. Although congenital stenoses and dilatation of the intrahepatic bile ducts are considered responsible for calculi formation, intrahepatic calculi are usually formed after cyst excision. In this study, bile specimens from patients with choledochal cysts were cultured for bacteria. Results were retrospectively analyzed among the following groups: the primary excision group, consisting of 97 patients undergoing cyst excision as a primary treatment ( mean age 5.0 years), the internal drainage group, consisting of 13 patients who had previous cyst-enterostomy at cyst excision ( mean age 20.2 years); and the hepatolithiasis group, consisting of 12 patients with postoperative hepatolithiasis ( mean age 24.2 years). Bacteria were present in the bile of 10 patients (76.9%) in the internal drainage group and in all patients (100%) in the hepatolithiasis group, but present in only 17 patients (17.5%) in the primary excision group (p< 0.01). Polymicrobial infection with Gram-negative enterobacteria such as Escherichia coli and Klebsiella species was predominant in the internal drainage and hepatolithiasis groups, while nonenteric bacteria were found in the primary excision group. Bile infection through bilioenterostomy may play an important role in intrahepatic calculus formation after excision of a choledochal cyst.