预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染效果的荟萃分析

Meta-analysis of effect of antibiotics prophylaxis on surgical incision infections after tension-free inguinal herniorrhaphy

目的评价预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染的作用,明确对于该类手术患者是否需要预防性使用抗菌药物。方法检索2000年1月-2013年11月所有公开发表的关于预防性使用抗菌药物对腹股沟无张力疝修术切口感染的影响,临床随机对照试验,对符合纳入标准的研究使用Revman5.2软件进行统计分析。结果按照筛选标准,共有14项随机对照试验,5 940例患者纳入研究,预防性使用抗菌药物组与未使用抗菌药物组患者一般情况及病例特征分布均衡,预防性应用抗菌药物组术后切口总体感染率2.82%及切口浅部感染率2.25%,较对照组的3.88%及4.36%明显降低(P<0.05),而切口深部感染率两组比较差异无统计学意义。结论行腹股沟疝无张力修补术术前预防性应用抗菌药物能有效降低切口浅部感染的发生率,而对预防切口深部感染无实质性效果。

OBJECTIVE To evaluate the effect of antibiotics prophylaxis on surgical incision infections after the tension-free inguinal herniorrhaphy so as to determine whether the patients undergoing such surgery need the antibiotics prophylaxis or not.METHODS The papers concerning the effect of antibiotics prophylaxis on the surgical incision infections after the tension-free inguinal herniorrhaphy,which were published from Jan 2000 to Jan 2013,were retrieved,then the clinical randomized controlled trial was performed,and the researches that conformed to the inclusion criteria were statistically analyzed by using the Revman5.2software.RESULTS According to the screening criteria,totally 14 randomized controlled trials were included,with 5940 patients involved;the baseline condition and the case characteristics showed an balanced distribution between the patients who used prophylactic antibiotics and the patients who did not.The overall incidence of postoperative incision infections was 2.82%in the antibiotics prophylaxis group,significantly lower than 3.88%in the control group;the incidence of superficial incision infections was 2.25%in the antibiotics prophylaxis group,significantly lower than 4.36%in the control group（P〈0.05）;however,there was no statistically significant difference in the incidence of deep incision infections between the two groups.CONCLUSIONS The preoperative antibiotics prophylaxis for the tension-free inguinal herniorrhaphy may contribute to the significant reduction of incidence of the superficial incision infections but has not substantive effect on the prevention of deep incision infections.