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前瞻性对照研究预防性抗生素在腹腔镜胆囊切除术中对感染率的临床效果。

Prospective Control Study of Clinical Effectiveness of Prophylactic Antibiotics in Laparoscopic Cholecystectomy on Infection Rate.

机构信息

Department of Surgery, Jeonbuk National University Hospital, Jeonju, Korea.

Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea.

出版信息

Yonsei Med J. 2021 Feb;62(2):172-176. doi: 10.3349/ymj.2021.62.2.172.

Abstract

PURPOSE

This study evaluated the effectiveness of prophylactic antibiotics in elective laparoscopic cholecystectomy (LCC) for the reduction of postoperative infection rate.

MATERIALS AND METHODS

Elective LCC was performed on 529 patients at Jeonbuk National University Hospital between April 2015 and August 2017. A total of 509 patients were enrolled based on the inclusion criteria. This prospective study compared the results for antibiotic group (AG) (n=249, cefotetan 1 g, 1 dose/prophylactic) and non-antibiotic group (NAG) (n=260).

RESULTS

There were no significant differences in clinical characteristics between the two groups: AG and NAG (=0.580, 0.782, and 0.325, respectively). Levels of C-reactive protein were higher in NAG compared to AG at postoperative day 2 (16.6±24.2 vs. 24.2±40.6; =0.033). There were no significant differences in white blood cell counts and erythrocyte sedimentation rate. Fever ≥38℃ on postoperative day 2 occurred in 3 (1.2%) and 9 (3%) patients in AG and NAG, respectively. One patient in each group had subhepatic fluid collection by abdominal computed tomography, but there was no evidence of infection. Two patients in NAG (3%) had serous wound drainage on postoperative day 14.

CONCLUSION

Our results showed no significant differences in patients receiving or not receiving prophylactic antibiotics during LCC. Therefore, it is not necessary to use prophylactic antibiotics during elective LCC in patients who meet the inclusion criteria.

摘要

目的

本研究评估了预防性抗生素在择期腹腔镜胆囊切除术(LCC)中降低术后感染率的效果。

材料与方法

2015 年 4 月至 2017 年 8 月,全罗北道国立大学医院对 529 例患者进行了择期 LCC。根据纳入标准,共纳入 509 例患者。本前瞻性研究比较了抗生素组(AG)(n=249,头孢替坦 1g,1 剂/预防)和非抗生素组(NAG)(n=260)的结果。

结果

两组间临床特征无显著差异:AG 和 NAG(=0.580、0.782 和 0.325)。与 AG 相比,NAG 术后第 2 天 C 反应蛋白水平更高(16.6±24.2 与 24.2±40.6;=0.033)。白细胞计数和红细胞沉降率无显著差异。AG 和 NAG 中分别有 3(1.2%)和 9(3%)例患者术后第 2 天发热≥38℃。AG 和 NAG 中各有 1 例患者腹部 CT 显示肝下积液,但无感染证据。NAG 中有 2 例(3%)患者术后第 14 天出现浆液性伤口引流。

结论

我们的结果表明,在 LCC 中接受或不接受预防性抗生素治疗的患者之间无显著差异。因此,对于符合纳入标准的择期 LCC 患者,无需使用预防性抗生素。

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本文引用的文献

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Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy.荟萃分析:择期腹腔镜胆囊切除术中的抗生素预防
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Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis.预防性抗生素在腹腔镜胆囊切除术中的作用:一项荟萃分析
J Gastrointest Surg. 2008 Nov;12(11):1847-53; discussion 1853. doi: 10.1007/s11605-008-0681-x. Epub 2008 Sep 9.
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