对于胰十二指肠切除术，抗生素是否有价值？

Are Antibiotics of Value for a Whipple Procedure?

机构信息

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: https://twitter.com/_JonahT.

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; GI Cancer Center, Pancreas and Biliary Surgery Program.

出版信息

Adv Surg. 2024 Sep;58(1):79-85. doi: 10.1016/j.yasu.2024.04.006. Epub 2024 May 23.

DOI:10.1016/j.yasu.2024.04.006

PMID:39089788

Abstract

Pancreatoduodenectomy is a complex surgical procedure with a high rate of morbidity, of which surgical-site infections (SSIs) make a large portion. Reduction of SSI rates is critical to decrease hospital lengths of stay, readmissions, delays in adjuvant therapies, and financial health care burden. Current clinical guidelines recommend the administration of cefoxitin as surgical prophylaxis prior to pancreatoduodenectomy. In April 2023, a randomized controlled trial was published in JAMA which showed that piperacillin-tazobactam as perioperative surgical prophylaxis prior to pancreatoduodenectomy decreased 30 day SSI rates (primary outcome), clinically relevant postoperative pancreatic fistula, postoperative sepsis, and Clostridium difficile infection rates.

摘要

胰十二指肠切除术是一种复杂的手术程序，发病率很高，其中手术部位感染（SSI）占很大比例。降低 SSI 率对于减少住院时间、再入院、辅助治疗延迟和医疗保健负担至关重要。目前的临床指南建议在胰十二指肠切除术前给予头孢西丁作为手术预防用药。2023 年 4 月，JAMA 发表了一项随机对照试验，结果表明，在胰十二指肠切除术前给予哌拉西林他唑巴坦作为围手术期手术预防用药可降低 30 天 SSI 率（主要结局）、临床相关的术后胰腺瘘、术后脓毒症和艰难梭菌感染率。