Lippert H, Gastinger J
Department of Surgery, Otto von Guericke University, Magdeburg, Germany.
Chemotherapy. 1998 Sep-Oct;44(5):355-63. doi: 10.1159/000007135.
Postoperative infection following cholecystectomy poses a significant threat to recovery, with major cost repercussions. Though antimicrobial prophylaxis is commonly practiced, its value - particularly in laparoscopic cholecystectomy - has not yet been adequately documented.
In a prospective multicenter quality assurance study in 28 German hospitals, an analysis of data collected on 4,477 patients undergoing conventional (n = 1,349) or laparoscopic (n = 3,128) cholecystectomy was performed; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover.
Postoperative infections occurred in a total of 136 patients, with infection rates of 5.0% in those without prophylaxis, 0.8% in those on ceftriaxone, and 1.2% in those on other antibiotic regimens. Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections, chest infections, other complications, reoperation and mortality.
Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future, especially since such measures also reduce hospital stay and hence the costs.
胆囊切除术后的感染对恢复构成重大威胁，并产生重大的成本影响。尽管抗菌预防措施普遍应用，但其价值——尤其是在腹腔镜胆囊切除术中——尚未得到充分记录。
在一项针对28家德国医院的前瞻性多中心质量保证研究中，对4477例行传统（n = 1349）或腹腔镜（n = 3128）胆囊切除术患者收集的数据进行了分析；2217例患者接受了围手术期抗生素覆盖，2260例未接受。
共有136例患者发生术后感染，未接受预防措施的患者感染率为5.0%，接受头孢曲松预防的患者感染率为0.8%，接受其他抗生素方案预防的患者感染率为1.2%。在术后伤口感染、肺部感染、其他并发症、再次手术和死亡率方面，接受预防措施的患者明显优于未接受预防措施的患者。
未来，无论是腹腔镜胆囊切除术还是传统开放性胆囊切除术，若无充分的围手术期抗菌预防措施均不应实施，特别是因为此类措施还可缩短住院时间并因此降低成本。
