Sarr M G, Parikh K J, Sanfey H, Minken S L, Cameron J L
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
Am J Surg. 1988 Feb;155(2):337-42. doi: 10.1016/s0002-9610(88)80728-1.
This randomized, prospective study has evaluated the efficacy of topical antibiotics in preventing infective complications in patients undergoing high-risk biliary surgery. Sixty-nine patients who underwent bile duct exploration, choledochoenteric anastomosis, or cholecystectomy, either for acute cholecystitis or because they were older than 65 years of age, were randomized to the following three groups: Group I, topical antibiotics alone (22 patients); Group II, cefoxitin and topical antibiotics (24 patients); and Group III, penicillin, tobramycin, clindamycin, and topical antibiotics (23 patients). The incidence of infective complications was no different among the groups. There was one wound infection in each group, one episode of bacteremia in Group II, and no intraabdominal abscesses. This study has demonstrated that parenteral antibiotics administered prophylactically in the perioperative period offer no additional benefit over the use of effective topical antibiotics used intraoperatively in patients undergoing high-risk biliary surgery.
这项随机前瞻性研究评估了局部使用抗生素对高危胆道手术患者预防感染性并发症的疗效。69例因急性胆囊炎或年龄超过65岁而接受胆管探查、胆总管肠吻合术或胆囊切除术的患者被随机分为以下三组：第一组，仅局部使用抗生素（22例患者）；第二组，头孢西丁和局部使用抗生素（24例患者）；第三组，青霉素、妥布霉素、克林霉素和局部使用抗生素（23例患者）。各组感染性并发症的发生率无差异。每组均有1例伤口感染，第二组有1次菌血症发作，且无腹腔内脓肿。这项研究表明，对于接受高危胆道手术的患者，围手术期预防性使用静脉抗生素并不比术中使用有效的局部抗生素更具优势。
