胃全摘術における抗生物質の短期間予防的投与法に関する検討 | The Effect of Short-Term Antimicrobial Prophylaxis Therapy after Total Gastrectomy

〔原　　著〕

胃全摘術における抗生物質の短期間予防的投与法に関する検討

宮澤　正紹，武藤　　淳，児山　　香，又吉　一仁
石井　　恒，齋藤　敬弘，芳賀淳一郎

福島労災病院外科

（受付2007年8月16日　受理2007年10月29日）

The Effect of Short-Term Antimicrobial Prophylaxis Therapy after Total Gastrectomy

MASATSUGU MIYAZAWA, ATUSHI MUTO, KAORI KOYAMA, KAZUHITO MATAYOSHI,
KOH ISHII, TAKAHIRO SAITO and JUNICHIRO HAGA

Department of Surgery, Fukushima Rosai Hospital, Fukushima, 973-8403, Japan

要旨: 胃全摘術における術後感染症に対する抗生剤の短期間予防的投与に関して検討した。
対象は2002年1月から2005年12月までに待機手術を行った胃全摘133例中，第2あるいは第3病日までの短期間投与を行った112例（2病日群: 65例，3病日群: 47例）とした。抗生物質は第1世代セフェム系（CEZ 2 g/day）を使用した。その術後感染症の発生状況を検討し，また経済性についても検証した。
術後SSIは11例（9.8%）に認めた。2病日群: 7例，3病日群: 4例（P=0.69）。創感染は2病日群: 2例，3病日群: 2例（3.1% vs 4.2%; NS）。腹腔内膿瘍は2病日群: 5例，3病日群: 2例（7.7% vs 4.2%; NS）であり両群間に有意差はなかった。
平均在院期間はSSI有が平均44.8日にたいしSSI無は平均32.2日と有意に長かった（P=0.028）。従って追加医療費は約30万円となった。
胃全摘術後感染予防の目的に使用する抗生物質は第1世代セフェム系を第2病日までの短期間投与で問題なかった。医療経済効果を考慮したSSI発症予防には抗生剤の投与法を含めた基本対策の徹底，および患者栄養管理，術中創縁保護，手術材料の選択などのさらなる対策が必要と思われた。

索引用語: 胃・胃手術・予防的抗生剤，術後感染症，医療経済

Abstract: Short-term antimicrobial prophylaxis for postoperative infections was evaluated in patients following total gastrectomy.
A retrospective study was conducted on 133 consecutive patients undergoing elective total gastrectomy between January 2002 and December 2005. Of these, 112 were treated with a first generation cefem antibiotic (CEZ, 2 g/day) either up to the 2nd day (n=65, hereafter called the 2-day group) or to the 3rd day (n=47, called the 3-day group). The incidence of postoperative infections and the economic effect of the treatment were investigated.
Postoperative surgical site infection (SSI) developed in 11 cases (9.8%). The incidence was similar in the two groups: 7 in the 2-day and 4 in the 3-day group (P=0.69). Wound infections developed in 2 in each group (3.1% vs. 4.2%; N.S.). Intraperitoneal abscesses were found in 5 cases in the 2-day group and 2 in the 3-day group (7.7% vs. 4.2%; N.S.). No significant difference was recognized between the two groups.
The mean duration of hospitalization by those with SSI was prolonged by about 12 days in comparison to those without (44.8 days vs. 32.2 days, P=0.028). Consequently, SSI incurred extra \300,000 in medical costs.
The administration of a first generation cefem antibiotic for two days presented no problems when used to prevent postoperative infections after total gastrectomy. To prevent the development of SSI in view of its effects on medical economics, further efforts are warranted to implement the basic procedures (including the use of antibiotics), in addition to various innovations such as nutritional care, protecting the surgical wounds during surgery and selecting appropriate surgical materials.

Key words: stomach, gastric surgery, antimicrobial prophylaxis, postoperative infection, medical economics