Macano Caw, Griffiths E A, Vohra R S
Department of Upper Gastrointestinal Surgery, University Hospitals of North Midlands, Stoke-on-Trent , Staffordshire , UK.
Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Foundation Trust , Birmingham , UK.
Ann R Coll Surg Engl. 2017 Mar;99(3):216-217. doi: 10.1308/rcsann.2017.0001. Epub 2017 Jan 10.
INTRODUCTION Current guidelines do not recommend antibiotic prophylaxis in elective laparoscopic cholecystectomy. Despite this, there is wide variation in antibiotic prophylaxis during cholecystectomy in population-based studies. The aim of this survey was to establish the current rationale for antibiotic prophylaxis in elective laparoscopic cholecystectomy. METHODS A short questionnaire was designed and disseminated across collaborators for a population-based study investigating outcomes following cholecystectomy and via the Association of Upper Gastrointestinal Surgeons, Researchgate and Surginet membership. RESULTS Responses were received from 234 people; 50.9% had no written policy for the use of prophylactic antibiotics in elective cholecystectomy; 5.6% never used antibiotics, while 30.8% always did and 63.7% selectively used antibiotics. Contamination with bile, stones and pus were scenarios in which antibiotics were most commonly used in selective practices to reduce infective complications. Interestingly, 87% of respondents would be happy to participate in a trial investigating the effectiveness of antibiotics in elective laparoscopic cholecystectomy where contamination has occurred. CONCLUSIONS The disparity between current practice and guidelines appears to arise because of a lack of evidence to show that antibiotics reduce surgical site infection following elective laparoscopic cholecystectomy where contamination has occurred. This question needs to addressed before practice will change.
引言 当前指南不建议在择期腹腔镜胆囊切除术中进行抗生素预防。尽管如此，在基于人群的研究中，胆囊切除术中抗生素预防的使用差异很大。本次调查的目的是确定择期腹腔镜胆囊切除术中抗生素预防的当前依据。方法 设计了一份简短问卷，并通过协作人员在一项基于人群的研究中进行传播，该研究调查胆囊切除术后的结果，并通过上消化道外科医生协会、Researchgate和Surginet会员进行传播。结果 共收到234人的回复；50.9%在择期胆囊切除术中没有关于预防性使用抗生素的书面政策；5.6%从不使用抗生素，而30.8%总是使用，63.7%选择性使用抗生素。胆汁、结石和脓液污染是在选择性手术中最常使用抗生素以减少感染并发症的情况。有趣的是，87%的受访者愿意参与一项试验，该试验调查在发生污染的择期腹腔镜胆囊切除术中抗生素的有效性。结论 当前实践与指南之间的差异似乎是由于缺乏证据表明抗生素能减少在发生污染的择期腹腔镜胆囊切除术后的手术部位感染。在实践改变之前，这个问题需要得到解决。
