Use of Ceftazidime in Hepatobiliary Surgery

肝膽外科手術在亞洲地區；包括台灣、是相當常見的疾病。而膽石症者常佔絶大多數的病例，其中肝內結石症又佔膽石症30～50％的大多數。術前使用PTC或PTCD，以及手術中所取得膽汁的培養，常顯示高比例的細菌感染，而其感染率與結石部位的分佈有相當密切的關連。肝內結石症膽汁培養顯示需氧菌(91.2%)、厭氧菌(43.9%)，而膽囊結石症則為需氧菌（26.4%）、厭氧菌（3.8%）。細菌的種類則以E. coli , Pseudomonas. Enterobacter 為最常見，當然也可見合併多種細菌感染。因此肝膽外科手術的病人，常需於術前或術後使用抗生素治療。 Ceftazidime是一種半合成的抗生素，在實驗室中對格蘭氏陰性細菌有相當好的抑制效果。因此我們在臨床上使用於接受手術治療的病人，並加以評估其效果。我們把病人分為兩組，一組為預防性的病人，抗生素的使用目的在於預防其術後感染。所得結果良好，並無病人感染。另一組為治療組，抗生素的使用在於術前和術後的治療。結困於臨床症狀有86.7%的病人得到改善，而細菌廓清率有69.9％，但是對抑制細菌的有效率則達91.3%。我們同時將實驗室培養所得的菌株與其他三代的抗生素比較MIC90的平均值，結果顯示Ce-ftazidime對於Pseudomonas‧aeuginosa有相當良好的效果。因此我們認為Ceftazidime於肝膽外科手術的病人具有良好的療效，其中特別以院內細菌感染為主的Pseudomonas有其優於他類抗生素的治療效果。

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並列摘要

Patients undergoing hepato-biliary surgery pose both diagnostic and therapeutic challenges. Such operations are commonly seen in Asian countries and especially in the Southern parts of Taiwan. Biliary pathogens are usually noticed when the disease coexists with gallstones. Bile stasis with bacterial infection predisposing to longstanding intermittent obstructive jaundice, cholangitis, liver abscess and septicemia results in high morbidity and mortality. Treatment is generally initiated with broad-spectrum antibiotics before operative intervention and culture results become available. The usual therapeutic regimen incudes beta-lactam agents with or without aminoglycoside. A clinical efficacy study was conducted using a single agent, ceftazidime, to treat twenty adults who underwent hepato-biliary surgery. Fiteen cases received ceftazidime as a therapeutic agent and five prophylactic ally. Thirteen of these patients showed clinical improvement with ceftazidime therapy and pathogens were eradicated in nine; the remaining six had aerobic Gram positive and anaerobic Gram negative bacteria presented;P. aeruginosa(1), E coli (1), Klebsiella oxytoca (1), Streptococcus faecalis (1) and Bacteroid fragilis (3). The prophylactive group showed no signs of infections following single dose pre-and post-operative boost injections of ceftazidime. Ceftazidime appears to be a useful agent in the treatment of patients undergoing hepato-biliary surgery, and especially those with Gram negative aerobic bacteria infections.

並列關鍵字

prophylzxis ； hepato-biliary surgery ； ceftzaidime

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Use of Ceftazidime in Hepatobiliary Surgery

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