甲状腺切除术不使用抗茵药物预防切口感染的可行性研究  

Feasiability study of prevention of incision infection without antibacterial medications for thyroidectomy

作　　者：覃谦[1] 李洪[1] 王力斌[1] 李爱辉[1] 陈丽菊[2] 欧阳杰[1] 梁卓虹[1] 谢书勤[1] 陈思远[1] 

机构地区：[1]中山大学附属东华医院普瘤外科,广东东莞523110 [2]中山大学附属东华医院手术室,广东东莞523110

出　　处：《中国实用医刊》2012年第24期19-22,共4页Chinese Journal of Practical Medicine

摘　　要：目的对中山大学附属东华医院甲状腺切除术围术期不使用抗菌药物预防切口感染进行回顾性分析。方法选择我院自2006年2月至2011年8月对667例甲状腺切除术患者不再常规预防性使用抗菌药物作为预防术后切口感染。其中结节性肿510例，腺瘤77例，原发性甲状腺机能进亢症29例，乳头状癌45例，其他恶性肿瘤3例。单侧结节性肿或腺瘤行一侧叶大部分或全叶切除术441例，结节性肿或原发性甲亢行双侧大部分切除195例，甲状腺乳头状癌同时行一侧颈淋巴结清扫7例，双侧颈淋巴结清扫1例。手术时间25～390min，平均79．8min。结果结节性肿行双侧大部分切除和原发性甲亢双侧次全切除术后因甲状腺残端继发性出血再次手术缝合止血各1例；结节性肿行右侧全切除术＋左侧次全切除术后并发喉返神经暂时性麻痹1例；结节性肿行双侧大部分术后5d并发颈部切口化脓感染l例。结论甲状腺手术作为I类切口，绝大多数患者手术范围小、时间短和出血量少等特点。只要注意无菌操作和严格止血，围术期完全没有必要常规预防性使用抗菌药物。除为患者或社会减轻大量的经济负担外，尤其是对防止因过度使用抗菌药物而导致细菌的耐药性出现将有重要的深远意义。Objective To study the feasiability of prevention of incision infection without periop- erative use of antibacterial medications for thyroidectomy. Methods Six hundred and sixty-seven pa- tients underwent thyroidectomy admitted in our hospital from Feb. 2005 to Aug. 2011 were enrolled in this study, they were not administered with antibacterial medications for prevention of postoperative inci- sion infection. There were 510 cases of nodular goiter, 77 cases of thyroid adenoma, 29 cases of Graves＇ disease, 45 cases of thyroid papillary carcinoma and 3 cases of other malignant tumors. Unilateral total , lobectomy or partial thyroidectomy was performed in 441 patients with single-side nodular goiter or thyroid adenoma; bilateral partial thyroidectomy was performed in 195 patients with nodular goiter or Graves＇ disease; unilateral neck lymph node resection was performed in 7 patients with thyroid papillary carcino- ma and bilateral neck lymph node resection was performed in one patient with thyroid papillary carcino- ma. The surgical procedure time raged from 25 -390 rain, the averaged time was 79. 8 rain. Results Re-suturing was performed in one patient due to secondary hemorrhage from residual thyroid following bi- lateral partial thyroidectomy for nodular goiter and 1 patient due to subtotal thyroidectomy for Graves＇ dis- ease. Temporally recurrent nerve paralysis was reported as complication following right-side total lobecto- my and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. Conclusions Classified as type-I incision, thyroidectomy has the characteristic of small incision, short duration and minor hemorrhage. The proce- dure is performed under strict conditions of sterility and hemostasis, there is no need to use antibacterial medications for the prevention of incision infection and thus the use of ~a^ntibiotics may be avoided. In ad- dition to alleviate the economic burden for patients of socie

关 键 词：甲状腺疾病 外科手术 抗菌药物 感染 

分 类 号：R65[医药卫生—外科学]