Larsson Per-Göran, Carlsson Bodil
Department of Obstetrics and Gynecology, Kärnsjukhuset, S-541 85 Skövde, Sweden.
Infect Dis Obstet Gynecol. 2002;10(3):133-40. doi: 10.1155/S1064744902000133.
Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy. Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV.
Women undergoing total abdominal hysterectomy for benign diseases were open-randomized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment. At the preoperative gynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate flora were merged to one group called abnormal vaginal flora.
In total 213 women were randomized to treatment or no treatment. After exclusion of 71 women, 142 women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm, compared with 27% in the 'no treatment' arm (p < 0.01). Treatment also reduced the vaginal cuff infection rate from 9.5 to 2% among the 83 women with lactobacilli flora. However, this difference was not statistically significant. Treatment had no effect on the rate of wound infections. Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women randomized to treatment.
Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora.
细菌性阴道病（BV）是腹部子宫切除术后感染的已知危险因素。阴道细菌菌群评分处于中间状态已被证明与BV具有相同的术后感染风险。
因良性疾病接受全腹子宫切除术的女性按照泽伦法进行开放随机分组，分别接受至少4天的直肠甲硝唑治疗或不接受治疗。在术前妇科检查时采集阴道涂片并进行革兰氏染色。患有BV或中间菌群的女性被合并为一组，称为异常阴道菌群。
共有213名女性被随机分组接受治疗或不接受治疗。排除71名女性后，142名女性符合分析条件。在59名被诊断为异常阴道菌群的女性中，治疗组未发生阴道残端感染，而未治疗组的感染率为27%（p<0.01）。在83名乳酸杆菌菌群的女性中，治疗也将阴道残端感染率从9.5%降至2%。然而，这种差异无统计学意义。治疗对伤口感染率没有影响。意向性分析显示，随机接受治疗的女性中阴道残端感染显著减少。
术前和术后至少4天直肠使用甲硝唑治疗可显著降低异常阴道菌群女性的阴道残端感染率。
