Illig K A, Schmidt E, Cavanaugh J, Krusch D, Sax H C
Department of Surgery, University of Rochester Medical Center, NY 14642, USA.
J Am Coll Surg. 1997 Apr;184(4):353-6.
Some clinicians administer prophylactic antibiotics routinely before laparoscopic cholecystectomy, and the results of some of the studies in the literature support this practice. We conducted a prospective randomized trial to determine whether administration of prophylactic antibiotics is necessary during routine laparoscopic cholecystectomy in low-risk patients.
Two hundred fifty patients without evidence of acute inflammation, common duct stones, or other indications for antibiotics were randomized to receive three perioperative doses of cefazolin or no prophylaxis and followed up for complications up to 30 days postoperatively. The primary end point was the occurrence of a major infectious complication, defined as that causing a systemic response, delaying discharge, or leading to readmission. Minor infectious problems were also noted, defined as those causing local symptoms only.
One hundred twenty-eight patients were randomized to receive prophylactic antibiotics (PA group), 122 to receive none (NONE group; two patients in this group were actually given preoperative antibiotics). Only one major complication occurred (in a patient in the NONE group), an abscess in the presence of a bile leak, despite the administration of antibiotics when the leak was discovered several days before infectious problems arose. There were four minor problems: two lower urinary tract infections and one superficial wound infection in a NONE patient and one urinary tract infection in a PA patient (not significant); all were easily managed. The prophylactic antibiotics did not sterilize the bile, and infectious complications were not associated with weight, inflammation found at the time of operation, reported stone or bile spill-age, or conversion to open operation.
Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy in low-risk patients.
一些临床医生在腹腔镜胆囊切除术之前常规使用预防性抗生素，文献中的一些研究结果支持这种做法。我们进行了一项前瞻性随机试验，以确定在低风险患者的常规腹腔镜胆囊切除术中是否有必要使用预防性抗生素。
250例无急性炎症、胆总管结石或其他抗生素使用指征的患者被随机分为两组，一组接受围手术期3剂头孢唑林，另一组不进行预防，术后随访30天观察并发症情况。主要终点是发生严重感染并发症，定义为引起全身反应、延迟出院或导致再次入院。还记录了轻微感染问题，定义为仅引起局部症状的问题。
128例患者被随机分配接受预防性抗生素治疗（PA组），122例不接受预防性抗生素治疗（无预防组；该组有2例患者实际上在术前使用了抗生素）。仅发生了1例严重并发症（在无预防组的1例患者中），即胆汁漏合并脓肿形成，尽管在感染问题出现前几天发现胆汁漏时已给予抗生素治疗。有4例轻微问题：无预防组有2例下尿路感染、1例表浅伤口感染，PA组有1例尿路感染（无统计学意义）；所有这些问题都很容易处理。预防性抗生素未能使胆汁无菌，感染并发症与体重、手术时发现的炎症、报告的结石或胆汁溢出或转为开腹手术无关。
对于低风险患者的择期腹腔镜胆囊切除术，预防性抗生素并非必要。
