Pitt H A, Postier R G, Gadacz T R, Cameron J L
Surgery. 1982 May;91(5):518-24.
Controlled studies have demonstrated that systemic prophylactic antibiotics significantly reduce the sepsis rate after biliary tract surgery. Other studies have documented the efficacy of topical antibiotic irrigation in decreasing the incidence of wound infection after a wide variety of procedures. Whether systemic antibiotics or the combination of systemic and topical antibiotics provide any advantage over topical antibiotics alone, however, has not been determined. Therefore, a prospective, randomized study was carried out comparing topical intra-abdominal and wound antibiotic irrigation (neomycin and polymyxin) with topical antibiotic irrigation plus parenteral antibiotics (gentamicin and penicillin) in 54 patients undergoing "high-risk" biliary surgery. All patients underwent either an elective common bile duct exploration or a biliary-enteric anastomosis for obstructive jaundice. Twenty-five patients were randomized to the group receiving only topical antibiotics, and 29 received topical plus systemic antibiotics. The two groups were similar with respect to age, sex, presence of common duct stones, incidence of jaundice, positive bile cultures at surgery, and type of surgery performed. There were three wound infections in each group, and no patient developed an intra-abdominal abscess. Other infectious complications occurred with similar frequency in the two study groups. This study suggests that topical antibiotics provide effective prophylaxis in biliary tract surgery and that broad-spectrum systemic antibiotic therapy is of no additional benefit. Topical antibiotics provide an alternative means of prophylaxis for patients discovered intraoperatively to be at "high risk" for infection.
对照研究表明，全身性预防性使用抗生素可显著降低胆道手术后的败血症发生率。其他研究记录了局部抗生素冲洗在降低多种手术后伤口感染发生率方面的疗效。然而，全身性抗生素或全身性与局部抗生素联合使用是否比单独使用局部抗生素具有任何优势，尚未确定。因此，进行了一项前瞻性随机研究，比较了54例接受“高危”胆道手术患者的腹腔内和伤口局部抗生素冲洗（新霉素和多粘菌素）与局部抗生素冲洗加胃肠外抗生素（庆大霉素和青霉素）的效果。所有患者均接受了择期胆总管探查术或因梗阻性黄疸进行胆肠吻合术。25例患者被随机分配到仅接受局部抗生素治疗的组，29例接受局部加全身性抗生素治疗。两组在年龄、性别、胆总管结石的存在、黄疸发生率、手术时胆汁培养阳性以及所进行的手术类型方面相似。每组均有3例伤口感染，且无患者发生腹腔内脓肿。两个研究组中其他感染并发症的发生频率相似。这项研究表明，局部抗生素在胆道手术中可提供有效的预防作用，而广谱全身性抗生素治疗并无额外益处。局部抗生素为术中发现有感染“高危”风险的患者提供了一种替代的预防方法。
