Guzmán-Valdivia Gilberto
Department of General Surgery, Regional General Hospital No 1 Gabriel Mancera, Mexican Institute of Social Security (IMSS), Mexico City, Mexico.
Surg Laparosc Endosc Percutan Tech. 2008 Dec;18(6):547-50. doi: 10.1097/SLE.0b013e3181809e72.
Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs.
To compare 2 groups of similar patients, to determine whether administration of antibiotics, started during surgery, is actually useful in reducing the risk of residual abscess or infection in the surgical wound.
The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy. This total was divided at random into 2 groups: group A (80 patients) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture, followed by 2 more doses at intervals of 8 hours in the immediate postoperative period; and group B (86 patients) who did not receive any antibiotic treatment at all. The dependent variables observed were surgical wound infection and residual abscess: and the control variables were age, sex, length of operation time, intercurrent illnesses, and American Society of Anesthesiologists (ASA) classification.
Two patients (2.5%) in group A developed a surgical wound infection, against 3 cases (3.4%) in group B, the result having no statistical significance. No patients developed residual abscess. In a multivariant analysis, the following were identified as independent factors significantly associated with the onset of surgical wound infection (P<0.001): diabetes mellitus, being over 60 years of age, operation time lasting longer than 70 minutes, and ASA 3.
Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60, or who have an ASA classification of 3 or more, or if the operation itself is likely to last more than 70 minutes, the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery.
胆囊意外破裂是一种在高达20%的腹腔镜胆囊切除术中发生的事件，主要发生在解剖困难的情况下，或在通过腹腔镜端口直接取出胆囊时。人们普遍认为腹腔内胆汁污染可能是感染的原因，并导致残余脓肿的形成，甚至导致手术伤口感染。因此，外科医生通常会在胆囊穿孔时开抗生素。
比较两组相似患者，以确定手术期间开始使用抗生素是否真的有助于降低残余脓肿或手术伤口感染的风险。
该研究共纳入166例在择期腹腔镜胆囊切除术中发生胆囊意外穿孔的患者。这些患者被随机分为两组：A组（80例患者）在胆囊破裂时接受1克头孢噻肟剂量，术后立即每隔8小时再给予两剂；B组（86例患者）根本不接受任何抗生素治疗。观察的因变量是手术伤口感染和残余脓肿；控制变量是年龄、性别、手术时间长度、并发疾病以及美国麻醉医师协会（ASA）分级。
A组有2例患者（2.5%）发生手术伤口感染，B组有3例患者（3.4%）发生手术伤口感染，结果无统计学意义。没有患者出现残余脓肿。在多变量分析中，以下因素被确定为与手术伤口感染发生显著相关的独立因素（P<0.001）：糖尿病、年龄超过60岁、手术时间持续超过70分钟以及ASA 3级。
在腹腔镜胆囊切除术中，对发生胆囊意外穿孔的患者常规应用抗生素没有必要。对于患有糖尿病、年龄大于60岁、ASA分级为3级或更高的患者，或者手术本身可能持续超过70分钟的患者，建议在术前即将手术前开始抗生素治疗。
