结、直肠癌手术中抗菌药物预防性应用的随机对照临床研究

A randomized controlled clinical study on antimicrobial prophylaxis in operations on the carcinoma of colon and rectum

设计一项前瞻性随机对照临床研究，比较了术前口服联合围手术期静脉给药途径与单一的术前口服给药途径在结、直肠癌手术中的预防效果。２４例结、直肠癌患者被随机分为２组。（１）口服组术前２ｄ每日口服庆大霉素和甲硝唑；（２）联合组除接受上述口服给药方案外，还与围手术期静脉滴注相同的抗菌药物。对肠道细菌进行定量培养，证实了术前口服庆大霉素和甲硝唑使肠道内需氧菌和厌氧菌的数量明显减少。还对围手术期血清和手术期间组织中庆大霉素和甲硝唑的浓度进行测定，口服组在手术期间血清和组织中甲硝唑均达有效浓度，但庆大霉素未能测出；联合组在手术期间血清和组织中两药均达有效浓度。结果提示，术前口服联合围手术期静脉给药途径较为合理。

A prospective randomized controlled clinical study was undertaken to compare prophylactic effects of preoperative oral antimicrobial regimen with preoperative oral plus perioperative intravenous antimicrobial regimen in colorectal surgery.24 patients with colorectal carcinoma were randomly assigned to receive preoperative oral gentamicin and metronidazole for two days together with perioperative intravenous the same drugs(the combined group)or purely preoperative oral gentamicin and metronidazole for two days(the oral group).Quantitative bacterial cultures of rectum content were performed.Results showed that preoperative oral antimicrobials resulted in a significant reduction in the mean counts of aerobes and anaerobes in the rectum in all patients(P<0.01).The perioperative blood samples and the intraoperative tissue specimens were taken for gentamicin and metronidazole determination.In the oral gruop,effective concentrations of metronidazole were found in serum and tissues but gentamicin was undetected.In the combined group,effective concentrations of both gentamicin and metronidazole were detected during the operation.These results suggest that preoperative oral plus perioperative intravenous antimicrobial regimen appears to be more rational.