den Hoed P T, Boelhouwer R U, Veen H F, Hop W C, Bruining H A
Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.
J Hosp Infect. 1998 May;39(1):27-37. doi: 10.1016/s0195-6701(98)90240-7.
In two hospitals 637 patients undergoing cholecystectomy between June 1989 and June 1993 were entered into a prospective audit. The aim of this study was to determine the incidence of postoperative infections, especially wound infections, after open and laparoscopic biliary surgery and to assess the bacteriological data on these patients. The incidence of minor wound infection was 10.4% (66/637), of major wound infection 3.6% (23/637) and the overall incidence was 14% (89/637). The incidence of wound infection after laparoscopic cholecystectomy was 5.3% (10/189) and all were minor. Significant specific risk factors for developing a wound infection after laparoscopic cholecystectomy were emergency of the operation (P = 0.046) and acute cholecystitis (P = 0.014). Overall, bile cultures were positive in 22%. There were 85 patients (13.3%) with positive bile from the gallbladder. From the laparoscopically operated patients 2.8% had a positive bile culture. The predominant micro-organisms from gallbladder bile were Escherichia coli (56 isolates), Klebsiella spp. (20 isolates) and Streptococcus spp. (16 isolates). There was no relationship between positive gallbladder cultures and wound infection. The consequences of wound infections can be serious and this study showed a morbidity rate comparable with the literature. The incisions used in laparoscopic gallbladder surgery are less susceptible to major problems. This combined with the significantly lower incidence of wound infections after laparoscopic cholecystectomy suggests that routine antibiotic prophylaxis as recommended for biliary surgery in general is now questionable.
1989年6月至1993年6月期间，在两家医院对637例行胆囊切除术的患者进行了前瞻性审计。本研究的目的是确定开放和腹腔镜胆道手术后术后感染的发生率，尤其是伤口感染率，并评估这些患者的细菌学数据。轻微伤口感染发生率为10.4%（66/637），严重伤口感染发生率为3.6%（23/637），总体发生率为14%（89/637）。腹腔镜胆囊切除术后伤口感染发生率为5.3%（10/189），均为轻微感染。腹腔镜胆囊切除术后发生伤口感染的显著特定危险因素是手术急诊（P = 0.046）和急性胆囊炎（P = 0.014）。总体而言，胆汁培养阳性率为22%。有85例患者（13.3%）胆囊胆汁培养阳性。腹腔镜手术患者中2.8%胆汁培养阳性。胆囊胆汁中的主要微生物是大肠杆菌（56株）、克雷伯菌属（20株）和链球菌属（16株）。胆囊培养阳性与伤口感染之间无相关性。伤口感染的后果可能很严重，本研究显示的发病率与文献报道相当。腹腔镜胆囊手术中使用的切口较不易出现重大问题。这与腹腔镜胆囊切除术后伤口感染发生率显著降低相结合，表明一般推荐的胆道手术常规抗生素预防措施现在值得怀疑。
