Turan Mehmet Ilker, Ozturk Durmaz Senay, Celik Mehmet, Akgul Nedim
Department of General Surgery, Kepez State Hospital, 07320 Antalya, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Kepez State Hospital, 07320 Antalya, Turkey.
Medicina (Kaunas). 2025 May 21;61(5):939. doi: 10.3390/medicina61050939.
The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised -tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. The postoperative WBC and CRP levels were significantly higher in the pABX group ( = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance ( = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006-1.031, = 0.004). Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens.
经口内镜甲状腺切除术-前庭入路（TOETVA）和甲状旁腺切除术-前庭入路（TOEPVA）是传统手术的无瘢痕替代方法，但由于口腔切口，被归类为清洁-污染手术，这引发了人们对手术部位感染（SSIs）的担忧。本研究评估在TOET/PVA中，与延长抗生素预防（eABX）相比，单纯围手术期抗生素预防（pABX）在预防SSIs方面是否足够，尤其考虑到手术学习曲线。一项回顾性研究分析了2018年1月至2024年6月在单一中心接受TOET/PVA的162例患者。患者分为两组：82例接受eABX（术前静脉注射头孢唑林加7天口服阿莫西林/克拉维酸），80例仅接受pABX（静脉注射头孢唑林）。纳入标准包括完整的术后血常规和C反应蛋白（CRP）记录；排除标准包括其他手术入路或数据缺失。结局指标包括术后白细胞（WBC）计数、CRP水平以及并发症（血清肿、蜂窝织炎和皮瓣穿孔），根据疾病控制与预防中心（CDC）指南进行定义。统计分析包括t检验、卡方检验和逻辑回归，并对年龄和性别等混杂因素进行了调整。pABX组术后WBC和CRP水平显著更高（P = 0.001），但所有值均保持在实验室正常范围内。14例患者出现并发症：11例血清肿，2例蜂窝织炎，1例皮瓣穿孔。eABX组并发症发生更频繁，但无统计学意义（P = 0.103）。eABX组手术时间更长（117.93±52.35 vs. 72.44±22.54分钟，P = 0.001），且是并发症的独立预测因素（OR = 1.018，95%CI：1.006 - 1.031，P = 0.004）。与TOETVA中的延长预防相比，单纯围手术期抗生素预防不会增加SSIs的风险。然而，由于手术时间更长和并发症风险更高，在学习曲线期间eABX可能更为谨慎。未来需要进行前瞻性随机试验以规范预防方案。
