一项有关乳腺癌手术抗菌药物预防性使用预防SSI的考克兰系统评价
Cochrane Database Syst Rev. 2012 Jan 18;1:CD005360.Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.
Bunn F, Jones DJ, Bell-Syer S.
Source
Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane,Hatfield, Hertfordshire, AL10 9AB, UK. f.bunn@herts.ac.uk.
Abstract
BACKGROUND:
Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery.
OBJECTIVES:
To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery.
SEARCH METHODS:
For this second update we searched the Cochrane Wounds Group Specialised Register (searched 31 August 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2008 to August Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 30 August 2011); Ovid EMBASE (1980 to 2011 Week 34); and EBSCO CINAHL (2008 to 25 August 2011). We applied no language or date restrictions.
SELECTION CRITERIA:
Randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions.
DATA COLLECTION AND ANALYSIS:
Two review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria.
MAIN RESULTS:
A total of nine studies (2260 participants) is included in the review. Eight studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.71, 95% confidence interval (CI) 0.53 to 0.94). Analysis of the single study comparing perioperative antibiotic with no antibiotic found no statistically significant effect of antibiotics on the incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour.
AUTHORS' CONCLUSIONS:
Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.术前预防性使用抗菌药物可减少乳腺癌手术部位感染的风险。研究表明，有关立即进行乳腺再造术的患者还有待进一步研究，因为这部分患者与不立即进行乳腺再造术的患者相比发生SSI的风险更高。
全文能否上传呀？ 从题目上看很吸引人，但看内容却看不懂，没办法，谁叫咱们英文水平低呢？谢谢！ 英文的看不懂，但最后的中文结论是正确的——放之四海而皆准。立即进行乳腺再造术的患者至少手术时间比不立即做再造手术的时间要长啊。{:1_7:} 盼望老师能上传全文，谢谢
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