证据表明预防性抗生素在直肠外科手术中可能是不必要的-系统性审查和元分析
James Jin1, Velia Men2, Maggie Wang1
1Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, Auckland, New Zealand.
World journal of surgery
|February 6, 2026
概括
常规的预防性抗生素不建议用于直肠手术,因为它们不能显著减少感染或伤口并发症. 需要进一步的大规模试验来证实这些发现对于抗生素预防.
科学领域:
- 手术瘤学手术瘤学
- 传染性疾病 传染性疾病
- 基于证据的医学基于证据的医学.
背景情况:
- 越来越多的人对抗菌素耐药性的担忧质疑在直肠外科手术中常规预防性抗生素的必要性.
- 目前在直肠外科手术中进行抗生素预防的处方实践缺乏一致的基于证据的指导.
- 这一系统性审查批判性地评估了现有关于预防性抗生素在选择性直肠手术中的现有文献.
研究的目的:
- 系统地评估当前关于预防性抗生素在选择性直肠手术中的作用的文献.
- 为了确定预防性抗生素是否可以减少手术部位感染和其他并发症.
- 为在门手术中使用抗生素提供基于证据的指导.
主要方法:
- 从1980年1月到2025年6月,在PubMed,Embase和Cochrane图书馆进行了全面的文献搜索.
- 主要结局是手术部位感染 (SSI);次要结局包括全身感染,伤口脱落,,出血和复发.
- 研究质量评估使用RCTs的Cochrane RoB 2.0和观察性研究的ROBINS-I;证据确定性评估使用GRADE.
主要成果:
- 纳入了9项涉及2317名参与者的研究;其中5项符合元分析的条件.
- 预防性抗生素在RCT (RR 0.76,中度GRADE确定性) 或观察性研究 (RR 0.60,非常低的确定性) 中没有显著减少术后感染性或伤口并发症.
- 所有包括的研究表明,在直肠手术中,常规抗生素预防可能不需要.
结论:
- 目前的证据不支持在不复杂的直肠手术中常规预防性抗生素的使用.
- 证据的确定性受到小样本大小,研究异质性和少量可用研究的限制.
- 大规模的随机对照试验是必要的,以加强抗生素预防在直肠外科手术的证据基础.
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