Darkahi Bahman, Videhult Per, Sandblom Gabriel, Liljeholm Haakan, Ljungdahl Mikael, Rasmussen Ib Christian
Department of Surgery, Enköping Hospital, Enköping, Sweden.
Scand J Gastroenterol. 2012 Oct;47(10):1242-6. doi: 10.3109/00365521.2012.711850. Epub 2012 Jul 30.
The aim of this study was to assess the benefit from antibiotic prophylaxis (AP) during cholecystectomy in a population-based cohort study.
All cholecystectomies performed in Uppsala County, 2003-2005, were registered prospectively according to a standardized protocol. High-risk procedures (HP) were defined as operations for acute cholecystitis and procedures including exploration of the common bile duct. Infections requiring surgical or percutaneous drainage and non-surgical infections that prolonged hospital stay were defined as major infectious complications (IC).
Altogether 1171 patients underwent cholecystectomy. AP was given to 130 of 867 (15%) of the patients undergoing low-risk procedures (LP) and 205 of 304 (67%) of those undergoing H-R P. Major IC were seen in 6 of 205 (3%) of the patients undergoing H-R P with AP and 1 of 99 of the patients undergoing H-R P without AP. No major IC was seen after L-R P. Minor IC were seen after 5 of 205 (2%) HP with AP, 1 of 99 (1%) HP without AP, 0 of 130 (0%) LP with AP, and 2 of 737 (0.3%) LP without AP. In univariate logistic analysis, the overall risk for IC was found to be higher with AP (p < 0.05), but the increase did not remain significant if adjusting for age, gender, ASA class, H-R P/L-R P and surgical approach or limiting the analysis to major IC.
There is no benefit from AP in uncomplicated procedures. The effectiveness of antibiotic prophylaxis in complicated cholecystectomy must be evaluated in randomized controlled trials.
本研究旨在通过一项基于人群的队列研究评估胆囊切除术中抗生素预防（AP）的益处。
2003年至2005年在乌普萨拉县进行的所有胆囊切除术均按照标准化方案进行前瞻性登记。高风险手术（HP）定义为急性胆囊炎手术以及包括胆总管探查的手术。需要手术或经皮引流的感染以及延长住院时间的非手术感染定义为主要感染并发症（IC）。
共有1171例患者接受了胆囊切除术。867例接受低风险手术（LP）的患者中有130例（15%）接受了AP，304例接受高风险手术（H-RP）的患者中有205例（67%）接受了AP。接受AP的205例H-RP患者中有6例（3%）出现主要IC，未接受AP的99例H-RP患者中有1例出现主要IC。LP术后未出现主要IC。接受AP的205例HP中有5例（2%）出现轻微IC，未接受AP的99例HP中有1例（1%）出现轻微IC，接受AP的130例LP中有0例（0%）出现轻微IC，未接受AP的737例LP中有2例（0.3%）出现轻微IC。在单因素逻辑分析中，发现AP患者IC的总体风险更高（p<0.05），但在调整年龄、性别、美国麻醉医师协会（ASA）分级、H-RP/LP和手术方式后，或仅分析主要IC时，这种增加并不显著。
在非复杂手术中，AP没有益处。抗生素预防在复杂胆囊切除术中的有效性必须在随机对照试验中进行评估。
