Unger Lukas Walter, Riss Stefan, Argeny Stanislaus, Bergmann Michael, Bachleitner-Hofmann Thomas, Herbst Friedrich, Stift Anton
Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Surgery, Hospital Barmherzige Brüder, 1020, Vienna, Austria.
Wien Klin Wochenschr. 2019 Mar;131(5-6):113-119. doi: 10.1007/s00508-019-1475-8. Epub 2019 Mar 6.
Recent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn's disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics.
In this study 255 consecutive patients who underwent a laparoscopic intestinal resection for CD at a tertiary referral center between 1997 and 2014 were retrospectively analyzed. Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestine ± ileocecal).
The baseline characteristics of the groups were comparable. Colorectal resections showed a significantly increased risk of organ/space infection (4.6% in small intestine ± ileocecal vs. 14.3% in colorectal resections p = 0.039). The superficial SSI rate was low in both groups (1.8% in small intestine ± ileocecal resection vs. 0% in colorectal resections, p = 1.000). Univariate binary logistic regression analysis revealed a statistically significant influence of duration of surgery (p = 0.001) and type of resection (p = 0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026-1.203 for every 10 min, p = 0.009) remained significant for postoperative organ/space infections.
Single-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with a low number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.
近期研究支持在接受克罗恩病（CD）手术的患者中使用机械肠道准备和/或口服抗生素预防；然而，相关数据稀缺，尤其是关于腹腔镜手术的。因此，本研究旨在调查腹腔镜手术对未接受标准化肠道准备但接受单次抗生素治疗的患者并发症发生率的影响。
本研究回顾性分析了1997年至2014年间在一家三级转诊中心连续接受腹腔镜CD肠切除术的255例患者。记录浅表手术部位感染（SSI）、器官/腔隙感染和肠梗阻情况，并根据切除类型（结直肠切除术与小肠±回盲部切除术）进行分组。
各组的基线特征具有可比性。结直肠切除术显示器官/腔隙感染风险显著增加（小肠±回盲部切除术为4.6%，结直肠切除术为14.3%，p = 0.039）。两组的浅表SSI发生率均较低（小肠±回盲部切除术为1.8%，结直肠切除术为0%，p = 1.000）。单因素二元逻辑回归分析显示手术时长（p = 0.001）和切除类型（p = 0.031）对器官/腔隙感染有统计学显著影响。多因素分析中，仅手术时长（每延长10分钟，OR为1.111，95%CI为1.026 - 1.203，p = 0.009）对术后器官/腔隙感染仍具有显著意义。
对于接受微创手术的患者，不进行肠道准备的单次抗生素治疗是安全的，且并发症数量较少；然而，如果进行结直肠切除术，器官/腔隙感染更为常见。因此，当涉及（乙状）结肠或直肠时，联合肠道准备可能有益。
