胆道闭锁Kasai肝门空肠吻合术后使用抗生素预防胆管炎的系统综述  

Antibiotic use for preventing cholangitis after Kasai portoenterostomy in biliary atresia patients: a systematic review

作　　者：陈迪 郑珊[1] 陈功[1] Chen Di;Zheng Shan;Chen Gong(Department of Surgery,Pediatric Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院外科,上海201102

出　　处：《临床小儿外科杂志》2024年第8期737-744,共8页Journal of Clinical Pediatric Surgery

基　　金：复旦大学附属儿科医院登峰交叉创新团队(EK112520180211)。

摘　　要：目的通过系统综述评估胆道闭锁Kasai肝门空肠吻合术后口服及静脉抗生素预防胆管炎的作用。方法对PubMed、Web of Science、EMBASE、Cochrane、Clinical trials等5个数据库进行文献检索,检索时间截至2024年3月18日。检索关键词包括"biliary atresia"、"bile duct abnormalities"、"portoenterostomy"、"anti bacterial agents"等。主要结局指标为胆管炎发生率,次要结局指标为自体肝生存率及黄疸清除率。结果共筛选出10篇符合纳排标准的文献,其中6篇涉及术后口服抗生素,4篇涉及术后静脉使用抗生素,共纳入991例患儿。部分研究支持口服抗生素对胆管炎的预防作用,其中1项研究表明抗生素组胆管炎发生率较非抗生素组低,差异有统计学意义(15%比57%,P<0.05),另1项研究也表明抗生素组胆管炎发生率更低(50%比77%),但差异无统计学意义(P>0.05);多数研究未发现胆管炎发生率存在显著差异,且对于自体肝生存率及黄疸清除率的影响结论不统一。3项研究表明更长时间的术后静脉抗生素使用对术后6个月及以上胆管炎发生率、黄疸清除率及自体肝生存率无显著影响(P>0.05),但可能降低术后1个月的胆管炎发生率(24%比39%,P<0.05)。结论目前仍需更多高质量研究证明口服及静脉使用抗生素预防术后胆管炎的有效性。Objective To evaluate the effectiveness of oral and intravenous antibiotics in preventing cholangitis after Kasai portoenterostomy(KP)in biliary atresia(BA)patients.Methods Literature searches were conducted in five databases,including PubMed,Web of Science,EMBASE,Cochrane,and Clinical Trials,with the cutoff date being March 18,2024.Search terms included"biliary atresia","bile duct abnormalities","portoenterostomy",and"anti-bacterial agents"etc.The primary outcome measured was the incidence of cholangitis,while secondary outcomes included native liver survival rate and jaundice clearance rate.Results Ten studies met the inclusion and exclusion criteria,with 6 involving oral antibiotics and 4 involving intravenous antibiotics post-surgery,encompassing a total of 991 patients.Some studies supported the preventive role of oral antibiotics against cholangitis;one study indicated a significantly lower incidence of cholangitis in the antibiotic group compared to the non-antibiotic group(15%vs.57%,P<0.05),and another showed a lower incidence(50%vs.77%),although the difference was not statistically significant(P>0.05).Most studies did not find significant differences in cholangitis incidence,native liver survival rate,or jaundice clearance rate.Three studies reported that prolonged postoperative intravenous antibiotics use had no significant effect on cholangitis incidence at six months or beyond,jaundice clearance rate,or native liver survival rate(P>0.05),but it may reduce the incidence of cholangitis at 1 month post-surgery(24%vs.39%,P<0.05).Conclusions More high-quality research is needed to confirm the effectiveness of oral and intravenous antibiotics in preventing postoperative cholangitis.Further studies are urgently needed.

关 键 词：胆道闭锁 外科手术 手术并发症 胆管炎 抗生素预防 

分 类 号：R65[医药卫生—外科学]