CAJ | 학술논문

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～ 390 min,平均79.8 min.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1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.
목적 대중산대학부속동화의원갑상선절제술위술기불사용항균약물예방절구감염진행회고성분석.방법 선택아원자2006년2월지2011년8월대667례갑상선절제술환자불재상규예방성사용항균약물작위예방술후절구감염.기중결절성종510례,선류77례,원발성갑상선궤능진항증29례,유두상암45례,기타악성종류3례.단측결절성종혹선류행일측협대부분혹전협절제술441례,결절성종혹원발성갑항행쌍측대부분절제195례,갑상선유두상암동시행일측경림파결청소7례,쌍측경림파결청소1례.수술시간25～ 390 min,평균79.8 min.결과결절성종행쌍측대부분절제화원발성갑항쌍측차전절제술후인갑상선잔단계발성출혈재차수술봉합지혈각1례；결절성종행우측전절제술+좌측차전절제술후병발후반신경잠시성마비1례；결절성종행쌍측대부분술후5d병발경부절구화농감염1례.결론 갑상선수술작위Ⅰ류절구,절대다수환자수술범위소、시간단화출혈량소등특점.지요주의무균조작화엄격지혈,위술기완전몰유필요상규예방성사용항균약물.제위환자혹사회감경대량적경제부담외,우기시대방지인과도사용항균약물이도치세균적내약성출현장유중요적심원의의.
Objective To study the feasiability of prevention of incision infection without perioperative use of antibacterial medications for thyroidectomy.Methods Six hundred and sixty-seven patients 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 incision 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 carcinoma and bilateral neck lymph node resection was performed in one patient with thyroid papillary carcinoma.The surgical procedure time raged from 25-390 min,the averaged time was 79.8 min.Results Re-suturing was performed in one patient due to secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy for nodular goiter and 1 patient due to subtotal thyroidectomy for Graves' disease.Temporally recurrent nerve paralysis was reported as complication following right-side total lobectomy 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 procedure 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 antibiotics may be avoided.In addition to alleviate the economic burden for patients of society,especially to prevent the excessive use of antibiotics lead to bacterial resistance will have far-reaching signifance.