择期腹腔镜胆囊切除围手术期预防性抗生素使用的meta分析

A meta-analysis of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy

目的用循证医学的方法,评价择期低风险的腹腔镜胆囊切除术围手术期预防性抗生素使用能否降低术后感染的发生率。方法检索1966年到2006年6月间发表的有关择期低感染风险的腹腔镜胆囊切除使用抗生素的随机对照临床试验。按入选和排除标准,有10项临床试验纳入本研究,由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果等内容独立进行摘录,用RevMan4.2软件进行分析。结果对于择期低感染风险的腹腔镜胆囊切除术抗生素使用组和无抗生素使用组两组之间切口感染(OR=0.68,95%CI:0.37～1.24,P=0.2)、腹腔感染(OR=0.67,95%CI:0.13～3.47,P=0.64)、其他部位感染(OR=0.39,95%CI:0.13～1.19,P=0.10)、胆囊内胆汁细菌培养(OR=0.8,95%CI:0.57～1.11,P=0.18)并无显著差异性。结论择期低感染风险的腹腔镜胆囊切除围手术期预防性抗生素的使用并不能降低术后感染的发生率。

Objective Although laparoscopic cholecystectomy （LC） is associated with a low incidence of infection, antibiotic prophylaxis is still commonly used in low-risk patients undergoing this procedure. The use of prophylactic antibiotics for LC is inconsistent and varies widely among surgeons. A meta-analysis was performed to assess the real efficacy of antibiotic prophylaxis in elective LC with respect to the postoperative infection rate. Methods Medline, EMBASE and China Biological Medicine Disk from January 1966 to June 2006 were retrieved for articles using the MeSHs of cholecystectomy, laparoscopic cholecystectomy, antibiotic prophylaxis, antibiotics and randomized controlled trials. Bibliographics of the .Journal articles were also searched for relevant studies. Only randomized trials that compared perioperative antibiotic prophylaxis with placebo or no treatment in lowrisk patients undergoing LC were selected. Low-risk patients were defined as those who did not have acute cholecystitis, common bile duct calculi, jaundice, immune suppression or prosthetic implants. Ten studies were enrolled for the analysis. The trials with Jadad score under 3 were regarded as low quality. The detail about the trial design, characters of the subjects, results of the studies were reviewed by 2 independent authors and analyzed by using Revman 4.2 software. Revman was used to calculate Peto＇s odds ratio （OR）. The precision of the estimation of OR by individual studies was used to calculate their contribution （or weight） to pooled OR. Results The results of the 10 studies had no conspicuous heterogeneity, thus the fixed effect model was used to analyze. Compared with placebo or no treatment, the antibiotic prophylaxis group was not significantly associated with lower incidence of wound infection （OR=0.68, 95%CI：0. 37-1. 24, P=0.2）, major infections （abdominal cavity infections） （OR： 0. 67, 95% CI： 0. 13-3.47, P = 0.64）, distant infection （including urinary tract infection, respiratory infection, etc） （OR=0. 39, 95%CI：0. 13-1. 19, P=0. 10） and bacterial culture of bile （OR=0.8, 95%CI：0. 57-1.11, P=0.18）. After eliminating the studies of low quality, we also had the same result. Conclusion Prophylactic antibiotics are not necessary for elective LC in low-risk patients.