Degrandi O, Buscail E, Martellotto S, Gronnier C, Collet D, Adam J P, Ouattara A, Laurent C, Dewitte A, Chiche L
Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.
Department of tissus engineering, INSERM UMR 1026, University of Bordeaux, Bordeaux, France.
J Surg Oncol. 2019 Sep;120(4):639-645. doi: 10.1002/jso.25622. Epub 2019 Jul 11.
Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT).
All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications.
We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors.
Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.
胰十二指肠切除术（PD）仍是一种创伤较大的手术。术前胆道引流（PBD）通常在手术前是必要的，但与胆道污染相关。我们比较了接受常规预防性抗生素（PAs）或系统性抗生素治疗（ABT）的PBD患者的术后并发症。
纳入2008年至2017年间接受手术的所有患者。2014年开始采用哌拉西林+他唑巴坦进行系统性围手术期ABT（ABT组）作为PBD的标准治疗方案。在此方案实施前接受标准头孢唑林治疗的患者作为对照组（PAs组）。主要结局是术后并发症。
我们纳入了122例行PBD手术的患者。两组在人口统计学方面无差异。围手术期ABT与深部腹腔脓肿减少相关（36%对10%，P = 0.0008）、呼吸道感染减少（15%对3%；P = 0.02）、菌血症减少（41%对6%；P < 0.0001）以及住院时间缩短（17[13 - 27]天对13[10 - 14]天；P < 0.0001）。ABT是预防深部腹腔脓肿发生的保护因素（比值比[OR]=0.16；P = 0.001），而吸烟（OR = 3.9）和胰瘘（OR = 19.1）是危险因素。
在PBD前行PD手术的患者中，系统性围手术期ABT可减少深部手术感染并缩短住院时间。
