预防性应用抗生素对无张力疝修补术后疗效的荟萃分析

doi:10.16139/j.1007-9610.2022.02.017

摘要/Abstract

摘要：

目的： 荟萃分析随机对照试验,比较预防性应用抗生素和安慰剂在无张力疝修补术中的疗效。方法： 计算机检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、数字化期刊全文数据库以及国外PubMed、Cochrane Library、Embase数据库收录的相关随机对照试验,提取数据进行合并分析。采用RevMan5.3软件进行荟萃分析。结果： 最终纳入10项随机对照试验,抗生素组和安慰剂组共包含3 659例病人。荟萃分析结果显示,抗生素组6项研究低风险环境中发生手术部位浅表感染的相对危险度（RR=0.74, 95%CI：0.45~1.24）,发生手术部位深部感染的相对危险度（RR=0.71, 95%CI：0.23~2.21）,与安慰剂组相比差异均无统计学意义。4项研究高风险环境中发生手术部位浅表感染的相对危险度（RR=0.34, 95%CI：0.12~0.95）优于安慰剂组,P=0.04。结论： 无张力疝修补术前预防性应用抗生素可能有助于降低高风险环境手术部位浅表感染发生率,但对低风险环境无明显作用。

关键词: 腹股沟疝, 无张力疝修补术, 抗生素, 荟萃分析, 随机对照试验

Abstract:

Objective To perform a meta-analysis of randomized controlled trial (RCT) comparing prophylactic antibiotics with placebo in patients with tension-free hernia repair for clinical effectiveness. Methods RCTs were searched from electronic Chinese databases including: ①China Biology Medicine Disc, ②China National Knowledge Infrastructure, ③China Science and Technology Journal Database, and ④Vanfund Urban Investment & Development, as well as electronic foreign databases including: PubMed, Cochrane Library, and Embase. The Review manager software (version 5.3) was used for statistical analysis. Results A total of 10 RCTs with both prophylactic antibiotic group and placebo group involving 3 659 patients were included. It was shown in this meta-analysis that there was no significant difference in the incidence of postoperative superficial incisional surgical site infection (SSSI) in low-risk environments (RR=0.74, 95% CI: 0.45-1.24) or postoperative deep surgical site infection (DSSI) (RR=0.71, 95% CI: 0.23-2.21) between two groups. The results from 4 RCTs showed that incidence of postoperative SSSI in high-risk environments in prophylactic antibiotic group was lower than that in placebo group(RR=0.34, 95%CI: 0.12-0.95, P=0.04). Conclusions Prophylactic antibiotics before tension-free hernia repair may help to reduce the incidence of postoperative SSSI in high-risk environments, but there is no significant evidence for that in low-risk environments.

Key words: Inguinal hernia, Tension-free hernia repair, Antibiotic, Meta-analysis, Randomized controlled trial

中图分类号:

R656.21

蒋维荣, 俞永江. 预防性应用抗生素对无张力疝修补术后疗效的荟萃分析[J]. 外科理论与实践, 2022, 27(02): 173-179.

JIANG Weirong, YU Yongjiang. A meta-analysis for efficacy of prophylactic antibiotics on tension-free hernia repair[J]. Journal of Surgery Concepts & Practice, 2022, 27(02): 173-179.

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纳入研究的基本特征[$\bar{x}\pm s$/中位数（最小值~最大值）/n]

纳入研究	分组	n	男/女	年龄（岁）	腹股沟疝类型	手术时间(min)	干预措施	随访时间(d)
Aufenacker等^[13] 2004	抗生素安慰剂	503 505	481/22 490/15	58.28±12.9 58.22±13.2	原发性单侧与双侧腹股沟疝	40 (30~50) 40 (28~51)	头孢呋辛1.5 g,术前静滴 1次	84
Ergul等^[14] 2012	抗生素安慰剂	100 100	95/5 89/11	48±17 50±15	原发单侧腹股沟疝	60 (35~160) 60 (40~135)	头孢唑林1 g,术前30 min 静滴1次	30
Jain等^[15] 2008	抗生素安慰剂	60 60	60/0 60/0	41.28±11.49 40.2±9.84	原发单侧腹股沟疝	56.33±11.67 60.33±6.81	阿莫西林克拉维酸 1.2 g,术前30 min静滴1次	28
Mazaki等^[16] 2014	抗生素安慰剂	100 100	89/11 94/6	69 (57~76) 72 (60~77)	单侧与双侧腹股沟疝	66.3±25.4 65.2±27.1	头孢唑林 1 g,术前30 min 静滴1次	90
Othman^[17] 2011	抗生素安慰剂	50 48	48/2 48/0	43.4±19.8 44.5±20.5	单侧与双侧腹股沟疝	38.8±10.8 40.9±11.1	阿莫西林克拉维酸1.2 g,术前30 min静滴1次	30
Perez等^[18] 2005	抗生素安慰剂	180 180	176/4 177/3	61.37±13.2 60.8±14.5	原发单侧腹股沟疝	52.18±16.4 54.07±15.3	头孢唑林 1 g,术前静滴1次	28
Tzovaras等^[19] 2007	抗生素安慰剂	190 189	179/11 177/12	63 (17~87) 63 (15~90)	单侧与双侧腹股沟疝	52.18±16.4 54.07±15.3	克拉维酸氨苄西林1.2 g,术前静滴1次	30
Tzovaras等^[19] 2007	抗生素安慰剂	190 189	179/11 177/12	63 (17~87) 63 (15~90)	单侧与双侧腹股沟疝	45 (20~90) 45 (20~80)	克拉维酸氨苄西林1.2 g,术前静滴1次	30
Yerdel等^[20] 2001	抗生素安慰剂	136 133	123/13 126/7	55.57±15.1 55.78±13.8	原发单侧腹股沟疝	64.18±22.8 62.78±19.3	氨苄西林舒巴坦1.5 g,术前静滴1次	360
严丽华等^[21] 2013	抗生素安慰剂	445 440	405/40 400/40	65±10 62±12	原发与复发腹股沟疝	- -	头孢唑林2.0 g,术前30 min 静滴1次	30
何金华等^[22] 2013	抗生素安慰剂	70 70	63/7 62/8	62.02±10.03 61.25±10.68	原发与复发腹股沟疝	37±6 38±5	头孢唑林 1.5 g,术前30 min 静滴1次	-

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