Avila Monica, Funston Jared R, Axtell Allison A, Lentz Scott E
*Departments of Obstetrics and Gynecology, and †General Surgery, Huntington Memorial Hospital, Pasadena; ‡Gynecologic Oncology, Kaiser Permanente, Los Angeles, CA.
Int J Gynecol Cancer. 2017 Oct;27(8):1783-1787. doi: 10.1097/IGC.0000000000001083.
Risk factors and infection rates of radical robotic procedures have yet to be described in gynecology. A practice improvement strategy using a solitary dose of vaginal metronidazole the night before surgery was initiated to determine if it decreased the risk of pelvic infection.
A retrospective chart review of robotic radical hysterectomies for gynecologic malignancy at our institution from April 2010 through April 2016 was performed. Demographic data, operative data, and data on use of metronidazole before surgery were collected. χ Statistical analysis, Student t test, and multivariate analysis were performed to analyze the data.
Ninety-four patients met the inclusion criteria, and 46 patients received vaginal metronidazole. Demographic and clinical factors were similar between the 2 groups. The pelvic infection rate was significantly higher in nonusers at 13% (6/46) compared with users at 0% (0/42) (P ≤ 0.05). The genitourinary infection rate was also significantly higher in nonusers at 20% as compared with users at 2.2% (P = 0.02). Operative risk factors found to be associated with pelvic infection included hospital length of stay, blood loss, and metronidazole use. Multivariate regression analysis determined that only vaginal metronidazole had a clinically significant reduction of pelvic and genitourinary infection.
A single dose of preoperative vaginal metronidazole reduces the risk of pelvic and genitourinary infection after robotic radical hysterectomy.
妇科机器人根治性手术的危险因素和感染率尚未见报道。启动一项术前一晚单次使用阴道甲硝唑的实践改进策略，以确定其是否能降低盆腔感染风险。
对2010年4月至2016年4月在我院接受妇科恶性肿瘤机器人根治性子宫切除术的患者进行回顾性病历审查。收集人口统计学数据、手术数据以及术前甲硝唑使用数据。进行χ²统计分析、学生t检验和多因素分析以分析数据。
94例患者符合纳入标准，46例患者接受了阴道甲硝唑治疗。两组的人口统计学和临床因素相似。未使用者的盆腔感染率显著高于使用者，分别为13%（6/46）和0%（0/42）（P≤0.05）。未使用者的泌尿生殖系统感染率也显著高于使用者，分别为20%和2.2%（P = 0.02）。发现与盆腔感染相关的手术危险因素包括住院时间、失血量和甲硝唑使用。多因素回归分析确定，只有阴道甲硝唑能显著降低盆腔和泌尿生殖系统感染风险。
术前单次使用阴道甲硝唑可降低机器人根治性子宫切除术后盆腔和泌尿生殖系统感染的风险。
