Wang Shufeng, Gao Qing, Qi Xiaogang, Hong Lihua, Huang Hai
Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, China.
Heliyon. 2025 Jan 28;11(4):e41982. doi: 10.1016/j.heliyon.2025.e41982. eCollection 2025 Feb 28.
The impact of prophylactic antibiotics on postoperative infection following laparoscopic cholecystectomy remains controversial. This meta-analysis and trial sequential analysis aims to assess the efficacy of prophylactic antibiotics in reducing the risk of postoperative infection following laparoscopic cholecystectomy.
Multiple databases including PubMed, Cochrane Library, EMBASE, and Web of Science were systematically searched to identify relevant randomized controlled trials (RCTs) published from inception to January 23, 2024. This study analyzed endpoints such as infection complications (IC) and surgical site infections (SSI). RCTs comparing prophylactic antibiotics versus placebo or no treatment in patients undergoing laparoscopic cholecystectomy were included. Data extraction and meta-analysis were performed. Additionally, trial sequential analysis was conducted to assess the robustness of evidence in meta-analysis.
Thirty-six RCTs with 9386 patients were included. The IC and SSI in prophylactic antibiotics group were significantly lower [pooled log risk-ratio (log RR): 0.37, 95 % confidence interval (CI):(-0.60, -0.14), p = 0.0017; pooled log RR: 0.30, 95 % CI (-0.51, -0.09), p = 0.01]. Trial sequential analysis revealed relative risk reductions of 33.09 % for IC and 27.96 % for SSI. Trial sequential analysis suggesting that the current evidence is robust. Studies involving low-risk patients and those with acute cholecystitis inclusion did not demonstrate a clear advantage in SSI reduction with prophylactic antibiotics.
Prophylactic antibiotics significantly reduces the risk of postoperative infection in patients undergoing laparoscopic cholecystectomy. Moreover, the lack of research on the impact of prophylactic antibiotics on postoperative infections in patients with acute cholecystitis undergoing laparoscopic cholecystectomy underscores the importance of further investigation.
预防性抗生素对腹腔镜胆囊切除术后感染的影响仍存在争议。本荟萃分析和试验序贯分析旨在评估预防性抗生素在降低腹腔镜胆囊切除术后感染风险方面的疗效。
系统检索多个数据库，包括PubMed、Cochrane图书馆、EMBASE和Web of Science，以识别从开始到2024年1月23日发表的相关随机对照试验（RCT）。本研究分析了感染并发症（IC）和手术部位感染（SSI）等终点指标。纳入了比较接受腹腔镜胆囊切除术患者使用预防性抗生素与安慰剂或不治疗的RCT。进行了数据提取和荟萃分析。此外，还进行了试验序贯分析，以评估荟萃分析中证据的稳健性。
纳入了36项RCT，共9386例患者。预防性抗生素组的IC和SSI显著更低[合并对数风险比（log RR）：0.37，95%置信区间（CI）：（-0.60，-0.14），p = 0.0017；合并对数RR：0.30，95%CI（-0.51，-0.09），p = 0.01]。试验序贯分析显示，IC的相对风险降低了33.09%，SSI降低了27.96%。试验序贯分析表明当前证据是稳健的。涉及低风险患者和纳入急性胆囊炎患者的研究未显示预防性抗生素在降低SSI方面有明显优势。
预防性抗生素显著降低了接受腹腔镜胆囊切除术患者的术后感染风险。此外，缺乏关于预防性抗生素对接受腹腔镜胆囊切除术的急性胆囊炎患者术后感染影响的研究凸显了进一步研究的重要性。
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