胆囊微创手术患者胆囊破裂后抗菌药物应用对手术部位感染影响的研究

Influence of no antibacterial agent use on incision infection after laparascopic cholecystectomy with gallbladder rupture

目的探讨胆囊破裂不应用抗菌药物对胆囊微创手术患者手术部位感染影响,为临床治疗提供参考依据。方法回顾性分析2010年1月-2016年5月择期全麻下腹腔镜胆囊切除术患者200例,将患者术中发生胆囊破裂以及使用抗菌药物的32例患者为抗菌药物组,患者术中发生胆囊破裂未使用抗菌药物的30例患者为无抗菌药物组,患者术中未发生胆囊破裂并未使用抗菌药物的138例患者为未破裂组,比较3组患者临床指标。结果抗菌药物组与无抗菌药物组的手术时间差异无统计学意义;无抗菌药物组、抗菌药物组胆囊三角粘连、胆囊与周边粘连的发生率均高于未破裂组;无抗菌药物组术后中性粒细胞高于抗菌药物组、未破裂组,差异均有统计学意义(P<0.05);术后切口感染10例患者,共分离出24株病原菌,革兰阴性菌14株占58.3%。结论择期腹腔镜胆囊切除术术中发生胆囊破裂时无需使用抗菌药物,对术后切口感染无明显影响。

OBJECTIVE To evaluate the influence of no antibacterial agent use on incision infections after laparascopic cholecystectomy with gallbladder rupture,so as to provide references for clinical treatment.METHODS A total of 200 patients scheduled for elective laparoscopic surgery from Jan.2010 to May 2016 were divided into antibacterial-agent group with gallbladder rupture（n=32,using antibacterial agent）,non-antibacterial-agent group with gallbladder rupture（n=30,no used antibacterial agent）,and non-gallbladder-rupture group without gallbladder rupture（n=138,no using antibacterial agent）.The clinical indexes of the three groups of patients were compared.RESULTS The operative time in antibacterial-agent group and non-antibacterial-agent group had no significance.The adhesion percentages of gallbladder triangle and gallbladder with peripheral tissues in antibacterialagent group and non-antibacterial-agent group were higher than those in non-gallbladder-rupture group,the neutrophil percentages in non-antibacterial-agent group were higher than those in antibacterial-agent group and nongallbladder-rupture group,and the differences were significant（P〈0.05）.There were 10 cases with incision infections.Totally 24 strains of pathogenic bacteria were isolated,and the gram-negative bacteria were 14 strains,accounting for 58.3%.CONCLUSIONIt is no need to use antibacterial agent in patients after laparascopic cholecystectomy with gallbladder rupture,which has no significant effect on incision infections.