Sheen-Chen S M, Chou F F
Department of Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung Medical College, Taiwan, R.O.C.
Surgery. 1994 Feb;115(2):170-5.
Postoperative choledochoscopy-related infection has been reported in the literature. We performed a prospective randomized trial to investigate the value of antibiotic prophylaxis for the prevention of such endoscopy-related infection.
In a 2-year period from 1990 to 1991, 84 patients with biliary lithiasis were included in the study and randomized. Forty-four patients received antibiotic prophylaxis (1 gm cephalothin intravenously 30 minutes before the procedure and 500 mg cephalexin orally every 6 hours for 3 days afterward). Forty patients in the control group did not receive any antibiotics.
There was no significant difference between the groups in age, sex, preprocedure liver function, serum amylase level, white cell count, and duration of the procedure. The results of bacteriologic studies of the bile were also comparable in the two groups. One patient in the control group had transient chill and fever after the procedure. Two patients in the antibiotic group and one patient in the control group had mild abdominal pain. Mild hemobilia was noted in one patient in the antibiotic group. These complications were treated conservatively without any event. No difference was evident in the complications and the success of postoperative choledochoscopy between the two groups.
This prospective randomized study showed that routine antibiotic prophylaxis for postoperative choledochoscopy may be not necessary in selected conditions.
文献中已报道了术后胆道镜检查相关感染。我们进行了一项前瞻性随机试验，以研究抗生素预防在预防此类内镜检查相关感染中的价值。
在1990年至1991年的2年期间，84例胆石症患者被纳入研究并随机分组。44例患者接受抗生素预防（术前30分钟静脉注射1克头孢噻吩，术后每6小时口服500毫克头孢氨苄，共3天）。对照组的40例患者未接受任何抗生素治疗。
两组在年龄、性别、术前肝功能、血清淀粉酶水平、白细胞计数和手术持续时间方面无显著差异。两组胆汁的细菌学研究结果也具有可比性。对照组有1例患者术后出现短暂寒战和发热。抗生素组有2例患者和对照组有1例患者出现轻度腹痛。抗生素组有1例患者出现轻度胆道出血。这些并发症经保守治疗，未发生任何不良事件。两组在并发症和术后胆道镜检查成功率方面无明显差异。
这项前瞻性随机研究表明，在特定情况下，术后胆道镜检查常规使用抗生素预防可能没有必要。
