Willis A T
Scand J Infect Dis Suppl. 1981;26:24-30.
The commonest complication of appendicetomy is surgical sepsis, the incidence of which may vary from 4% for normal appendices to 77% for gangrenous or perforated appendices. Although some of these infections are relatively trivial others are serious or even life-threatening. In an effort to reduce the incidence of serious sepsis surgeons have used a variety of topical and systemic prophylactic antibacterial agents such as penicillin, ampicillin, tetracycline, lincomycin, tobramycin, cephalosporins, neomycin, bacitracin, polymyxin and povidone iodine. Although none of these prophylactic procedures has been consistently effective, appropriate systemic antibiotics generally reduce the incidence of intra-abdominal sepsis, while appropriate local treatment reduces the incidence of wound infection. Most reports on the chemoprophylaxis of sepsis after appendicectomy have been concerned solely with clinical aspects of infection and have not considered the nature of the infecting agents. During the last few years there has been an increasing awareness of the importance of non-sporing anaerobes as the major cause of sepsis after surgery of the gastrointestinal tract. Studies carried out at the Luton and Dunstable Hospital and subsequently at other centres have shown that systemic metronidazole, which is a specifically anaerobicidal agent, is highly effective in preventing the development of sepsis due to anaerobes in postappendicetomy patients.
阑尾切除术最常见的并发症是手术部位感染，其发生率因阑尾情况而异，正常阑尾为4%，坏疽或穿孔阑尾则高达77%。虽然其中一些感染相对轻微，但其他一些则较为严重甚至危及生命。为降低严重感染的发生率，外科医生使用了多种局部和全身预防性抗菌药物，如青霉素、氨苄西林、四环素、林可霉素、妥布霉素、头孢菌素、新霉素、杆菌肽、多粘菌素和聚维酮碘。尽管这些预防措施都并非始终有效，但适当的全身抗生素通常可降低腹腔内感染的发生率，而适当的局部治疗则可降低伤口感染的发生率。大多数关于阑尾切除术后感染化学预防的报告仅关注感染的临床方面，而未考虑感染病原体的性质。在过去几年中，人们越来越意识到无芽孢厌氧菌是胃肠道手术后感染的主要原因。卢顿和邓斯特布尔医院以及随后其他中心进行的研究表明，全身使用甲硝唑（一种专门针对厌氧菌的药物）对预防阑尾切除术后患者因厌氧菌引起的感染非常有效。
