Moroni M, Baccolo M, Cavalli G, Belloni C, Ferrari N, Sartor V
Prog Clin Biol Res. 1979;35:43-52.
Surgical procedures on contaminated tissues, such as hysterectomy with opened vagina, are frequently followed by local or systemic infections. It seems that a prolonged antibiotic prophylaxis is not justified because of possible induction of resistant mutants or dysmicrobisms. The administration of antibiotics only in a short pre- and postsurgical period appears to be more rational. We have carried out a controlled clinical trial with the aim of evaluating the efficacy of this prophylactic practice. One hundred forty-five patients submitted to vaginal and two hundred seventy-five to abdominal hysterectomy entered this study (started September 1977). All patients received local nitrofurantoin treatment and were then subdivided into four randomized groups: control group, groups treated with thiamphenicol, cephazolin, thiamphenicol plus cephazolin, respectively. Each antibiotic was administered in the dose of 1 gm one hour before and five and 12 hours after surgery. Antibiotics were chosen taking into consideration the usual vaginal microbial flora, notoriously mixed (aerobic and anaerobic). The three treated groups presented a significant decrease in the incidence and severity of infectious complications. The use of antibiotics in the postoperative period resulted in significantly reduced morbidity in the treated groups. Thiamphenicol appears to be the most effective drug. Bacteriological studies showed that local treatment of the vagina decreased the bacteria charge, but never brought about sterilization.
对受污染组织进行的外科手术，如经开放阴道的子宫切除术，术后常伴有局部或全身感染。由于可能诱导耐药突变体或菌群失调，长期使用抗生素预防似乎不合理。仅在手术前后短时间内使用抗生素似乎更为合理。我们进行了一项对照临床试验，旨在评估这种预防措施的效果。145例行阴道子宫切除术和275例行腹部子宫切除术的患者进入本研究（始于1977年9月）。所有患者均接受局部呋喃妥因治疗，然后被随机分为四组：对照组、分别接受甲砜霉素、头孢唑林、甲砜霉素加头孢唑林治疗的组。每种抗生素均在手术前1小时、术后5小时和12小时各给予1克剂量。选择抗生素时考虑了常见的阴道微生物菌群，众所周知其为混合菌群（需氧菌和厌氧菌）。三个治疗组的感染并发症发生率和严重程度均显著降低。术后使用抗生素使治疗组的发病率显著降低。甲砜霉素似乎是最有效的药物。细菌学研究表明，阴道局部治疗可减少细菌数量，但从未实现灭菌。
