假体乳房再造术的感染与抗生素应用策略

Infection and antibiotic application strategies of prosthetic breast reconstruction

假体乳房再造术是乳腺癌术后乳房再造的最常用的手术方式,但术后感染率较高,是导致再造手术失败的重要原因。目前国内对外科手术围手术期抗生素的使用有严格限制,增加了临床医生对假体再造术后感染控制的难度,现对于假体乳房再造术中局部是否可以使用抗生素仍有不同认识,对围手术期抗生素的使用方法和时间缺乏共识。该文系统分析了目前假体乳房再造术后的感染、影响因素以及预防控制策略,得出以下结论:(1)假体乳房再造术后的感染发生率(2.5%~24.0%)明显高于其他清洁手术。(2)应用扩张器或假体、脱细胞异体真皮、术后放疗和引流时间长等是增加假体乳房再造感染率的因素。(3)预防性应用抗生素、采用混合抗生素溶液冲洗假体置入腔隙,可以有效降低乳房再造术后感染发生率。(4)术后延长抗生素应用的利弊尚需进一步研究。(5)在预防性应用抗生素后发生感染的情况下,需要使用替代性抗生素。

Prosthetic breast reconstruction is the most common surgical procedure for breast reconstruction after breast cancer surgery,but the high rate of postoperative infection is a major cause of failure of reconstruction surgery.Currently there are strict restrictions on the use of perioperative antibiotics in surgery,making it more difficult for clinicians to control postoperative infections after prosthetic reconstruction.Until now,there is still a different understanding of whether antibiotics can be used locally in prosthetic breast reconstruction,and there is a lack of consensus on the method and timing of perioperative antibiotic use.This review systematically summarized current infections,factors,and strategies of prosthetic breast reconstruction.Taken together,the incidence of infection after prosthetic breast reconstruction(2.5%to 24.0%)is significantly higher than other clean procedures.The application of expander or prostheses,acellular allogeneic dermis,adjuvant radiotherapy and long-time drainage are factors that increase the rate of infection in prosthetic breast reconstruction.Prophylactic application of antibiotics and flushing the prosthesis with a mixed antibiotic solution into the cavity can effectively reduce the incidence of infection after breast reconstruction.The pros and cons of prolonging the use of antibiotics after surgery need further research.In case of infection after prophylactic application of antibiotics,alternative antibiotics are required.