Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
HPB (Oxford). 2014 Jun;16(6):592-8. doi: 10.1111/hpb.12170. Epub 2013 Aug 29.
Although mortality following pancreaticoduodenectomy is decreasing, postoperative morbidity remains high. It was hypothesized that culture-directed treatment of bacteriobilia would decrease the incidence of infectious complications following pancreaticoduodenectomy.
In a retrospective study of 197 pancreaticoduodenectomy patients, those in the control group (n = 128, 2005-2009) were given perioperative prophylactic antibiotics, whereas those in the treatment group (n = 69, 2009-2011) were continued on antibiotics until intraoperative bile culture results became available. Patients with bacteriobilia received 10 days of antibiotic treatment, which was otherwise discontinued in patients without bacteriobilia. Various complication rates were compared using Fisher's exact test for categorical variables, Wilcoxon rank sum test for ordinal variables, and a two-sample t-test for continuous variables.
Demographics, comorbidities, baseline clinical characteristics, and intraoperative and postoperative variables were similar between the two groups. There were higher incidences of elevated creatinine (19% versus 4%; P = 0.004) and preoperative hyperglycaemia (18% versus 7%; P = 0.053) in the control group. Fewer patients in the control group underwent preoperative biliary stenting (48% versus 67%; P = 0.017) and intraperitoneal drains were placed at the time of resection more frequently in the control group (85% versus 38%; P < 0.001). Bacteriobilia was found in 59% of patients. Treatment of bacteriobilia was associated with a decrease in the rate of postoperative wound infections (12% in the control group versus 3% in the treatment group; P = 0.036) and overall complication severity score (1 in the control group versus 0 in the treatment group; P = 0.027).
Prolonged antibiotic therapy for bacteriobilia may decrease postoperative wound infection rates after pancreaticoduodenectomy. A randomized prospective trial is warranted to provide evidence to further support this practice.
尽管胰十二指肠切除术的死亡率正在下降，但术后发病率仍然很高。有人假设，针对细菌培养阳性的胆汁进行有针对性的治疗，会降低胰十二指肠切除术后感染性并发症的发生率。
在对 197 例胰十二指肠切除术患者进行的回顾性研究中，对照组（n = 128，2005-2009 年）接受围手术期预防性抗生素治疗，而治疗组（n = 69，2009-2011 年）则在术中胆汁培养结果出来之前继续使用抗生素。如果患者的胆汁中存在细菌，则给予 10 天的抗生素治疗；如果胆汁中不存在细菌，则停止使用抗生素。使用 Fisher 确切检验比较分类变量，使用 Wilcoxon 秩和检验比较有序变量，使用两样本 t 检验比较连续变量。
两组患者的人口统计学、合并症、基线临床特征、术中及术后变量均相似。对照组患者的肌酐升高发生率（19%比 4%；P = 0.004）和术前高血糖发生率（18%比 7%；P = 0.053）更高。对照组患者术前胆道支架置入率较低（48%比 67%；P = 0.017），而对照组患者术中更频繁地放置腹腔引流管（85%比 38%；P < 0.001）。59%的患者存在细菌培养阳性的胆汁。治疗细菌培养阳性的胆汁与降低术后伤口感染发生率（对照组 12%比治疗组 3%；P = 0.036）和整体并发症严重程度评分（对照组 1 分比治疗组 0 分；P = 0.027）相关。
针对细菌培养阳性的胆汁进行延长抗生素治疗可能会降低胰十二指肠切除术后伤口感染的发生率。需要进行随机前瞻性试验，以提供进一步支持这种治疗的证据。
