临床研究(Clinical Research)

择期腹腔镜胆囊切除术预防性使用抗生素的作用Meta 分析

Published at: 2015年第24卷第2期

汪超 1 , 黄强 1 , 林先盛 1 , 刘臣海 1 , 杨骥 1 , 胡俊 1
1 安徽医科大学附属省立医院 普外科胆胰外科/ 肝胆胰安徽省重点实验室,安徽 合肥 230001
通讯作者 强 黄 Email: hq-sohu@sohu.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.02.020
基金:

摘要

目的:评价预防性使用抗生素在择期腹腔镜胆囊切除术中的作用。方法:检索相关数据库,收集在2003 年1 月—2014 年12 月期间公开发表的关于预防性使用抗生素在择期腹腔镜胆囊切除术的随机对照试验(RCT),按纳入排除标准进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.2.10 软件进行Meta 分析。结果:最终共纳入9 篇RCT 研究,共2 316 例患者,其中预防组1 165 例,对照组1 151 例。Meta 分析结果显示,预防组与对照组比较,术后总感染率(RR=0.98,95% CI=0.59~1.61)、表浅切口感染率(RR=0.82,95% CI=0.48~1.41)及胆汁培养阳性率(RR=0.82,95% CI=0.64~1.05)差异均无统计学意义(均P>0.05);在纳入包含糖尿病及胆绞痛的RCT 中,总感染率及表浅切口感染率差异无统计学意义(均P>0.05)。结论:择期腹腔镜胆囊切除术预防性使用抗生素不能降低术后感染的发生率,但该结论仍需多中心、大样本、前瞻性RCT 研究验证。


Efficacy of antibiotic prophylactic regimens in elective laparoscopic cholecystectomy: a Meta-analysis

Abstract

Objective: To evaluate the efficacy of antibiotic prophylactic regimens in elective laparoscopic cholecystectomy. Methods: The randomized controlled trials (RCTs) concerning use of prophylactic antibiotics in elective laparoscopic cholecystectomy publicly published between January 2003 and December 2013 were collected by searching the relevant online databases. After literature screening according to inclusion and exclusion criteria, data extraction and methodological quality evaluation, a Meta-analysis was performed using RevMan 5.2.10 software. Results: Nine RCTs were finally included, involving 2 316 patients with 1 165 cases in prophylactic group and 1 151 cases in control group. The results of Meta-analysis-based comparison between prophylactic group and control group showed no statistical difference (all P>0.05) in terms of the overall postoperative infection rate (RR=0.98, 95% CI=0.59–1.61), superficial incisional surgical site infection rate (RR=0.82, 95% CI=0.48–1.41) and positive rate of bile culture (RR=0.82, 95% CI=0.64–1.05), as well as no statistical difference in the overall postoperative infection rate and superficial incisional surgical site infection rate in the included RCTs that recruited patients with diabetes and biliary colic (both P>0.05). Conclusion: Antibiotics for prophylaxis cannot reduce the incidence of postoperative infection in elective laparoscopic cholecystectomy, but this conclusion still needs to be proven by large sample and multicenter prospective RCTs.


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引用

引用本文: 超 汪, 强 黄, 先盛 林, 臣海 刘, 骥 杨, 俊 胡. 择期腹腔镜胆囊切除术预防性使用抗生素的作用Meta 分析[J]. 中国普通外科杂志, 2015, 24(2): 258-264.
Cite this article as: WANG Chao, HUANG Qiang, LIN Xiansheng, LIU Chenhai, YANG Ji, HU Jun . Efficacy of antibiotic prophylactic regimens in elective laparoscopic cholecystectomy: a Meta-analysis[J]. Chin J Gen Surg, 2015, 24(2): 258-264.