急性胆囊炎围手术期应用抗生素研究

Clinical Study on Perioperative Use of Prophylactic Antibiotics in Acute Cholecystitis

目的通过前瞻性随机对照研究探讨急性胆囊炎围手术期应用抗生素的必要性。方法将自2016年1月—2017年1月在该院因急性胆囊炎行腹腔镜胆囊切除术患者60例随机分为3组,A组20例:术前、术后均不用抗生素。B组20例:术前0.5~2h预防性静脉滴注二代头孢,术后2 h再次静脉滴注二代头孢。C组20例:入院后即开始静脉滴注二代头孢,术后静脉滴注二代头孢,2次/d。观察患者术后体温情况,白细胞变化,切口感染、腹腔感染等。结果全部60例病例,均完成腹腔镜胆囊切除术,其中术中胆囊破损4例,留置腹腔引流管4例。切口感染2例,术后随访3个月,无腹腔感染患者。结论急性胆囊炎围手术期可不使用抗生素,并不增加术后感染几率。

Objective This paper tries to investigate prospectively the perioperative use of prophylactic antibiotics in acute cholecystitis.Methods 60 cases from January 2016 to January 2017 in this hospital underwent laparoscopic cholecystectomy for acute cholecystitis were randomly divided into three groups,group A with 20 patients:preoperative and postoperative no antibiotics.Group B:20 patients with preoperative prophylactic intravenous drip in 0.5~2 h of the second generation cephalosporins,2 h after intravenous drip again the second generation cephalosporins.Group C:20 cases of intravenous drip the second generation cephalosporins after admission,postoperative intravenous drip the second generation cephalosporins,twice a day.Changes were observed in patients with postoperative body temperature,white blood cells,incision infection,abdominal cavity infection,etc.Results 60 patients were performed successfully under laparoscopy.4 patients with rupture of gallbladder in operation.4 patients had abdominal drainage after laparoscopic cholecystectomy.2 patients with wound infection.All patients were follow-up for 3 months.There were no intra-abdominal infection and abscess.Conclusion There is no need to use prophylactic antibiotics,which will not increase the rate of postoperative infection in emergency laparoscopic cholecystectomy.