经肛门内镜显微手术前预防性应用抗生素的临床价值

Clinical value of preoperative antibiotics in transanal endoscopic microsurgery

摘要:

目的  探讨术前预防性使用抗生素在经肛门内镜显微手术（TEM）中的临床价值。方法 选取30例于该院行TEM手术治疗直肠肿瘤的患者作为研究对象，随机分为抗生素组和对照组，抗生素组为术前和术后均应用抗生素，对照组为仅术后应用抗生素。评估患者术前和术后血沉（ESR）、C-反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）、中性粒细胞（NE%）和体温（T）等指标的变化。结果  抗生素组患者术后第1天和第3天ESR、CRP、WBC、NE%和T均明显低于对照组（P <0.05），并且WBC、NE%和T在术后第3天较术后第1天有明显的下降趋势。对于PCT，在术后第1天两组比较差异有统计学意义，抗生素组低于对照组（P <0.05），但在术后第3天，两者之间差异无统计学意义（P >0.05）。结论  术前预防性应用抗生素对TEM微创手术引起的炎症减轻和感染预防可能有一定的临床价值，但最终结论仍需要扩大病例数进一步研究。

Abstract:

Objective To investigate the clinical values of preoperative antibiotics in transanal endoscopic microsurgery (TEM). Methods Thirty patients undergoing TEM for rectal neoplasms in our hospital were selected in this study. All the patients were randomly divided into two groups. In antibiotic group antibiotics were used before and after surgery, and in control group antibiotics were used only after surgery. Several markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), neutrophils (NE%) and temperature (T) were evaluated before and after surgery in all the patients. Results The patients in the antibiotic group showed lower values of ESR, CRP, WBC, NE% and T than the control group on the 1st and 3rd day after surgery (P < 0.05). Furthermore, the WBC and NE% were significantly decreased on the 3rd day after surgery compared with those on the 1st day after surgery. PCT of the observation group was significantly lower than that of the control group on the 1st day after surgery (P < 0.05), but no significant difference was observed between them on the 3rd day after surgery (P > 0.05). Conclusions The preoperative application of antibiotics in TEM surgery for rectal neoplasms may be a promising method in reducing inflammation and preventing infection after surgery, which should be verified by substantial study on a large sample.