腹腔镜胆囊切除术中胆囊破裂不应用抗生素对切口感染的影响

Effects of No Antibiotic Use on Incisional Infection After Laparoscopic Cholecystectomy with Gallbladder Rupture

目的探讨在不常规使用抗生素情况下,择期低危腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术中胆囊破裂是否对术后切口感染等造成影响。方法对我院2014年1-12月226例择期LC的临床资料进行回顾性分析,比较胆囊破裂组与非破裂组手术时间、术后血白细胞、中性粒细胞比例、切口感染发生率、术后住院时间等。结果胆囊破裂组手术时间（54.4±3.8）min,明显长于非破裂组（45.1±2.8）min（t=-19.046,P=0.000）;胆囊破裂组胆囊与周边粘连、胆囊三角粘连比例较非破裂组明显增多（χ^2=72.756,P=0.000;χ^2=48.836,P=0.000）;术后白细胞计数、中性粒细胞比例明显高于非破裂组[（13.37±3.12）×10-9/L vs.（9.50±2.43）×10^-9/L,t=10.502,P=0.000;（82.91±5.29）%vs.（76.32±7.18）,t=6.037,P=0.000];术后切口感染胆囊破裂组1例,非破裂组2例,2组比较差异无统计学意义（Fisher精确检验,P=0.529）;术后住院时间2组均为（4.5±0.7）d,差异无统计学意义（t=0.000,P=1.000）。结论择期低危LC术中胆囊破裂患者无须预防性应用抗生素,对术后切口感染、住院时间无明显影响。

Objective To investigate whether administration of antibiotics is useful in reducing the risk of the surgical wound infection after elective laparoscopic cholecystectomy with gallbladder rupture. Methods A total of 226 patients who underwent elective laparoscopic cholecystectomy in our hospital from January 2014 to December 2014 were retrospectively analyzed. The operation time,postoperative incisional infection incidence and hospitalization time between the gallbladder ruptured group and non-ruptured group were compared. Results The ruptured group＇s operation time was（ 54. 4 ± 3. 8） min,higher than that in the non-ruptured group [（ 45. 1 ± 2. 8） min,t =- 19. 046,P = 0. 000]. The adhesion percentages of gallbladder with peripheral tissues and gallbladder triangle were significantly higher in the ruptured group than in the non-ruptured group（ χ^2= 72. 756,P = 0. 000; χ^2= 48. 836,P = 0.000）. The WBC counts and neutrophils percentages in the ruptured group were significantly higher than those in the non-ruptured group after surgery [（ 13. 37 ± 3. 12） × 10^-9/ L vs.（ 9. 50 ± 2. 43） × 10^-9/ L,t = 10. 502,P = 0. 000;（ 82. 91 ± 5. 29） % vs.（ 76. 32± 7. 18）,t = 6. 037,P = 0. 000]. The ruptured group had 1 case of postoperative incisional infection,whereas the non-ruptured group had 2 cases,without statistically significant difference（ Fisher＇s test,P = 0. 529）. The hospitalization time after surgery was（ 4. 5 ±0. 7） d in both groups,without statistical significance（ t = 0. 000,P = 1. 000）. Conclusion It＇s no need to use prophylactic antibiotics in low risk patients undergoing elective laparoscopic cholecystectomy,which has no significant effect on postoperative wound infection and hospital stay.