Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial
Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial
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DOI：
10.1007/s00268-012-1572-6
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发表时间：
2012-08-01
影响因子：
2.6
通讯作者：
Eid, Ahmed
中科院分区：
文献类型：
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作者：
Mazeh, Haggi;Mizrahi, Ido;Eid, Ahmed
目前治疗急性结石性胆囊炎的建议包括使用静脉注射抗生素，尽管这些建议从未经过科学验证。本研究的目的是评价静脉抗生素治疗在轻度急性结石性胆囊炎患者中的作用，在这项前瞻性、随机对照试验中，84例诊断为轻度急性结石性胆囊炎的患者被随机分配到仅支持治疗组或支持治疗加静脉抗生素治疗组（每组42例）。随访患者入院至延迟腹腔镜胆囊切除术，两个研究组在人口统计学数据、临床表现和疾病严重程度方面没有差异。在意向治疗基础上进行分析。静脉注射抗生素组的患者更早恢复流质饮食（1.7 vs. 2.2天，p = 0.02），但在恢复常规饮食（2.8 vs. 3.2天，p = 0.16）或住院时间（LOS）（3.9 vs. 3.8天，p = 0.89）方面无显著差异。静脉抗生素组患者的经皮胆囊造口术置管率（12 vs. 5%，p = 0.43）、再入院率（19 vs. 13%，p = 0.73）和围手术期病程与未接受抗生素组相似。两组的总体住院LOS（包括首次住院和随后的胆囊切除术）相似（5.6 vs. 5.1天，p = 0.29）。8例（19%）支持组患者在首次入院时交叉至静脉抗生素组，静脉抗生素治疗不能改善大多数轻度急性结石性胆囊炎患者的住院过程或早期预后。
Current recommendations for treating acute calculus cholecystitis include the use of intravenous antibiotics, although these recommendations were never tested scientifically. The aim of this study was to evaluate the role of intravenous antibiotic therapy in patients with mild acute calculus cholecystitis.In this prospective, randomized controlled trial, 84 patients with a diagnosis of mild acute calculus cholecystitis were randomly assigned to supportive treatment only or supportive treatment with intravenous antibiotic treatment (42 patients in each arm). Patients were followed through their index admission and until delayed laparoscopic cholecystectomy was performed.The two study groups did not differ in their demographic data or in the clinical presentation and disease severity. Analysis was conducted on the intent-to-treat basis. Patients in the intravenous antibiotics arm resumed a liquid diet earlier (1.7 vs. 2.2 days, p = 0.02) but did not significantly differ in resumption of regular diet (2.8 vs. 3.2 days, p = 0.16) or hospital length of stay (LOS) (3.9 vs. 3.8 days, p = 0.89). Patients in the intravenous antibiotics arm had rates of percutaneous cholecystostomy tube placement (12 vs. 5 %, p = 0.43), readmissions (19 vs. 13 %, p = 0.73), and perioperative course similar to those not receiving antibiotics. The overall hospital LOS, including initial hospitalization and subsequent cholecystectomy, was similar for both groups (5.6 vs. 5.1 days, p = 0.29). Eight (19 %) patients in the supportive arm were crossed over to the intravenous antibiotic arm during the index admission.Intravenous antibiotic treatment does not improve the hospital course or early outcome in most of the patients with mild acute calculus cholecystitis.