Yoshida Soichiro, Masuda Hitoshi, Yokoyama Minato, Kobayashi Tsuyoshi, Kawakami Satoru, Kihara Kazunori
Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Int J Urol. 2007 May;14(5):384-7. doi: 10.1111/j.1442-2042.2006.01728.x.
Recently, some studies suggested that antimicrobial prophylactics (AMP) are not needed to prevent surgical site infection (SSI) for clean operations despite worldwide acceptance of AMP. However, appropriate use of AMP in urological surgery has not been fully studied. Herein, we report an attempt of gradual decrease of AMP to non-use of AMP in minimum incision endoscopic urological surgery (MEUS) of adrenal and renal tumors.
We investigated 95 consecutive patients who underwent 16 MEUS adrenalectomy and 79 MEUS radical and partial nephrectomy in our hospital. Patients were classified into the following three groups by means of prevention of SSI: the first step group received ampicillin sodium/sulbactam sodium 1.5 g i.v. 30 min before the operation; the second step group received a single 300 mg of levofloxacin orally 60 min before the operation; and the third step group received no AMP. Clinical backgrounds and incidences of SSI were compared among these three groups.
The first, second and third step groups consisted of 31, 36 and 28 patients, respectively. There was no statistically significant difference among these groups in terms of clinical backgrounds including age, sex, body mass index, American Society of Anesthesiologists classification, National Nosocomial Infections Surveillance risk index, and type and length of operation. The first step group had one superficial SSI that healed without any non-specific treatment. None of the second and third step groups had superficial SSI. There was no case of deep surgical site or distant infection.
AMP could be discarded in clean MEUS of adrenal and renal tumors without increasing the incidence of SSI.
最近，一些研究表明，尽管抗菌预防药物（AMP）在全球范围内被广泛接受，但对于清洁手术，预防手术部位感染（SSI）可能并不需要使用AMP。然而，AMP在泌尿外科手术中的合理应用尚未得到充分研究。在此，我们报告了在肾上腺和肾肿瘤的最小切口内镜泌尿外科手术（MEUS）中逐步减少AMP用量直至不使用AMP的尝试。
我们调查了我院连续95例行16例MEUS肾上腺切除术和79例MEUS根治性及部分肾切除术的患者。根据预防SSI的方法，将患者分为以下三组：第一步组在手术前30分钟静脉注射1.5克氨苄西林钠/舒巴坦钠；第二步组在手术前60分钟口服单次300毫克左氧氟沙星；第三步组不使用AMP。比较这三组的临床背景和SSI发生率。
第一步组、第二步组和第三步组分别由31例、36例和28例患者组成。在包括年龄、性别、体重指数、美国麻醉医师协会分级、国家医院感染监测风险指数以及手术类型和时长等临床背景方面，这三组之间无统计学显著差异。第一步组有1例表浅SSI，未经任何特殊治疗即愈合。第二步组和第三步组均无表浅SSI。无深部手术部位感染或远处感染病例。
在肾上腺和肾肿瘤的清洁MEUS中可以不使用AMP，而不增加SSI的发生率。
