生物补片植入腹股沟疝无张力疝修补后预防性应用抗生素的荟萃分析

Effectiveness of prophylactic antibiotic administration for inguinal hernia repair with biological patch: A Meta-analysis

背景:预防性应用抗生素在腹股沟疝无张力修补后非常普遍,但是,不加选择的应用抗生素会增加患者的费用及抗生素耐药。目的:系统评价预防性应用抗生素对腹股沟疝无张力疝修补术后手术部位感染发生率的影响。方法:计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库,用RevMan5.0软件进行统计分析。结果与结论:纳入8篇随机对照试验进行分析,Meta分析结果显示:预防性应用抗生素和安慰剂在预防腹股沟疝无张力疝修补术后手术部位感染发生率方面两组间差异有显著性意义[RR=0.68,95%CI(0.49,0.94)];而敏感性分析结果提示:两组差异无显著性意义[RR=0.78,95%CI(0.56,1.10)]。亚组分析提示β-内酰胺类抗生素和安慰剂相比在预防腹股沟疝无张力疝修补后手术部位感染发生率方面差异无显著性意义[RR=0.63,95%CI(0.16,2.57)],头孢类抗生素和安慰剂相比差异也无显著性意义[RR=0.66,95%CI(0.41,1.06)]。结果提示,没有足够的证据支持腹股沟疝无张力疝修补后常规预防性应用抗生素。

BACKGROUND： Prophylactic antibiotics are very common following tension-free inguinal hernia repair; however, indiscriminate use of antibiotics will increase the cost and antibiotic resistance of patients. OBJECTIVE： To systematic review the effectiveness of prophylactic antibiotic administration in reducing postoperative wound infection rates in inguinal hernia repair. METHODS： We searched PubMed, EMBASE, the Cochrane Library, CBM, CNKI, VIP databases, and the data were analyzed using Review Manager 5.0. RESULTS AND CONCLUSION： Eight randomized controlled trials were included. The Meta analysis showed that there was significant difference between prophylactic antibiotic group and placebo group in surgical site infection rate [RR=0.68, 95%CI（0.49, 0.94）]; The heterogeneity analysis did not reach statistical significance neither for the sensitivity analysis [RR=0.78, 95%CI（0.56, 1.10）] nor in the sub-groups analysis[RR=0.63, 95%CI（0.16, 2.57） for comparison between β-lactam antibiotics and placebo] [RR=0.66, 95%CI（0.41, 1.06） for comparison between cephalosporins and placebo]. There was not enough evidence to support routine prophylactic antibiotic administration for inguinal hernia repair.