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扁桃体脓肿切除术后抗生素治疗是必需的吗?

[Is postoperative antibiotic treatment mandatory after abscess tonsillectomy].

作者信息

Knipping S, Löwe S, Lautenschläger C, Schrom T

机构信息

Universitätsklinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf - und Halschirurgie der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland.

出版信息

HNO. 2009 Mar;57(3):230-8. doi: 10.1007/s00106-008-1777-z.

Abstract

BACKGROUND

Peritonsillar abscess (PTA) is a common and serious complication of acute exudative tonsillitis. We wanted to answer the following question: Are postoperative antibiotics mandatory after abscess tonsillectomy?

PATIENTS AND METHODS

In an epidemiological observational study, 283 patients (98 females and 185 males, age range 2-72 years) were treated with abscess tonsillectomy for PTA. For a prospective randomized multicenter study, 105 patients were divided into two groups; one group was treated postoperatively with benzylpenicillin, and antibiotics were omitted in the control group. We evaluated postoperative pain scores, swallowing disorders, and well-being. Additionally, laboratory parameters such as C-reactive protein, leukocytes, and antistreptolysin titer were measured, and blood cultures were collected.

RESULTS

Male patients in the 2nd-4th decades of life were predominantly affected, mostly in the summer. For the patients in the two groups, we assessed no significant differences in either the subjective or the laboratory parameters. The blood cultures showed no evidence of bacteremia.

CONCLUSIONS

We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for PTA. No higher complication rate was found when additional antibiotic treatment was not used. Because of the small number of cases, the results can be regarded only as a tendency, not as a general recommendation.

摘要

背景

扁桃体周脓肿(PTA)是急性渗出性扁桃体炎常见且严重的并发症。我们想要回答以下问题:脓肿扁桃体切除术后抗生素是必需的吗?

患者与方法

在一项流行病学观察性研究中,283例患者(98例女性和185例男性,年龄范围2至72岁)接受了脓肿扁桃体切除术治疗PTA。在一项前瞻性随机多中心研究中,105例患者被分为两组;一组术后接受苄星青霉素治疗,对照组未使用抗生素。我们评估了术后疼痛评分、吞咽障碍和健康状况。此外,测量了诸如C反应蛋白、白细胞和抗链球菌溶血素滴度等实验室参数,并采集了血培养样本。

结果

主要受影响的是20至40岁的男性患者,大多在夏季。对于两组患者,我们在主观参数或实验室参数方面均未评估出显著差异。血培养未显示菌血症迹象。

结论

我们得出结论,立即进行脓肿扁桃体切除术是治疗PTA的一种有效且安全的方法。未使用额外抗生素治疗时未发现更高的并发症发生率。由于病例数量较少,结果仅可视为一种趋势,而非普遍推荐。

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