Yan Rui-Cheng, Shen Shi-Qiang, Chen Zu-Bing, Lin Fu-Sheng, Riley Jan
Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
J Laparoendosc Adv Surg Tech A. 2011 May;21(4):301-6. doi: 10.1089/lap.2010.0436. Epub 2011 Mar 28.
Although laparoscopic cholecystectomy (LC) is a common and widely applied technique, the use of antibiotics during the perioperative period in infection prevention remains controversial. In our study, a meta-analysis was performed to assess the impact of antibiotic prophylaxis on the postoperative infection rate in LC.
A literature search was conducted on studies published between January 1966 and March 2010 that involved LC and prophylactic administration of antibiotics. Only randomized trials that compared perioperative antibiotic prophylaxis with placebo or no treatment in low-risk patients undergoing LC were selected. Eighteen studies qualified according to the inclusion criteria, but only 12 were of adequate quality according to the Jadad scale to be included for the meta-analysis. Data were analyzed via the Peto odds ratio (OR) method and run using RevMan 4.2 software. The precision of the estimation of OR by individual studies was used to calculate their contribution (or weighting) to the pooled OR.
The results of the 12 studies did not have significant heterogeneity, and thus, the fixed effect model was used for data analysis. Compared with placebo or no treatment, there was no significant risk reduction in the antibiotic prophylaxis group with regard to overall infections (OR=1.11; 95% confidence interval [CI], 0.68-1.82; P=.67), wound infections (OR=1.07; 95% CI, 0.59-1.94; P=.99), major infections (OR=2.88; 95% CI, 0.3-28.09; P=.36), distant infections (OR=1.01; 95% CI, 0.43-2.36; P=.99), or positive bile cultures (OR=0.76; 95% CI, 0.54-1.08; P=.12). However, prophylactic antibiotics did shorten length of hospital stay (weighted mean difference=-0.16; 95% CI, -0.22 to -0.09; P<.01).
Prophylactic antibiotics are not necessary for elective LC in low-risk patients.
尽管腹腔镜胆囊切除术（LC）是一种常见且广泛应用的技术，但围手术期使用抗生素预防感染仍存在争议。在我们的研究中，进行了一项荟萃分析以评估抗生素预防对LC术后感染率的影响。
对1966年1月至2010年3月期间发表的涉及LC和抗生素预防性给药的研究进行文献检索。仅选择在接受LC的低风险患者中比较围手术期抗生素预防与安慰剂或不治疗的随机试验。18项研究符合纳入标准，但根据Jadad量表，只有12项质量足够可纳入荟萃分析。数据通过Peto比值比（OR）方法进行分析，并使用RevMan 4.2软件运行。通过个体研究对OR估计的精度来计算其对合并OR的贡献（或权重）。
12项研究的结果没有显著异质性，因此，采用固定效应模型进行数据分析。与安慰剂或不治疗相比，抗生素预防组在总体感染（OR = 1.11；95%置信区间[CI]，0.68 - 1.82；P = 0.67）、伤口感染（OR = 1.07；95% CI，0.59 - 1.94；P = �.99）、严重感染（OR = 2.88；95% CI，0.(3 - 28.09；P = 0.36）、远处感染（OR = 1.01；95% CI，0.43 - 2.36；P = 0.99）或胆汁培养阳性（OR = 0.76；95% CI，0.54 - 1.08；P = 0.12）方面，感染风险没有显著降低。然而，预防性抗生素确实缩短了住院时间（加权平均差 = -0.16；95% CI，-0.22至-0.09；P < 0.01）。
对于低风险患者的择期LC，预防性抗生素并非必要。
