Sanchez-Manuel Francisco Javier, Lozano-García Javier, Seco-Gil Juan Luis
General and Digestive Surgery, Complejo Asistencial Universitario de Burgos. Hospital General Yagüe, Burgos, Spain.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD003769. doi: 10.1002/14651858.CD003769.pub4.
The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.
The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair.
We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline using the following terms: #1 antibiotic* OR antimicrob* OR anti infecti* OR antiinfecti*; #2 prophyla* OR prevent*; #3 #1 AND #2; #4 clean AND (surgery OR tech* OR proced*); #5 herni*; #6 (wound infection) AND #4; #7 #3 AND (#4 or #5 or #6). National Research Register, ISI-Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled-trials.com and clinicaltrials.gov) were checked to identify further studies.
Only randomised clinical trials were included.
In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta-analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis.
The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 - 0.82). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 - 0.81).
AUTHORS' CONCLUSIONS: Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.
鉴于该领域研究结果存在差异，目前疝修补术中抗生素预防的应用是一个有争议的问题。
本系统评价的目的是阐明抗生素预防在降低择期开放性腹股沟疝修补术后伤口感染率方面的有效性。
我们通过将术语herni和inguinal或groin以及术语antimicr或antibiot作为自由文本和医学主题词，检索了Cochrane结直肠癌组专业注册库。在Medline中使用以下术语进行了类似的检索：#1抗生素或抗微生物或抗感染或抗感染*；#2预防或预防；#3 #1 AND #2；#4清洁AND（手术或技术或程序）；#5疝*；#6（伤口感染）AND #4；#7 #3 AND（#4或#5或#6）。检查了国家研究注册库、ISI-Web、DARE、Scirus、TRIP数据库、NHS EED、纳入研究的参考文献列表以及临床试验注册网站（www.controlled-trials.com和clinicaltrials.gov）以识别更多研究。
仅纳入随机临床试验。
在本评价中，我们于2011年10月检索了符合条件的试验。这发现了四项新纳入的试验，因此荟萃分析中纳入了17项试验。其中11项使用假体材料进行疝修补（疝成形术），而其余研究未使用（疝修补术）。根据是否使用假体材料进行了汇总分析和亚组分析。分析中使用了固定效应模型。
纳入的患者总数为7843例（预防组：4703例，对照组：3140例）。预防组和对照组的总体感染率分别为3.1%和4.5%（比值比0.64，95%可信区间0.50 - 0.82）。疝修补术患者亚组中，预防组和对照组的感染率分别为3.5%和4.9%（比值比0.71，95%可信区间0.51 - 1.00）。疝成形术患者亚组中，预防组和对照组的感染率分别为2.4%和4.2%（比值比0.56，95%可信区间0.38 - 0.81）。
基于本系统评价的结果，不能普遍推荐对择期腹股沟疝修补术使用抗生素预防。当观察到伤口感染率高时，也不能推荐反对使用。
