微创医学

目的系统评价贲门失弛缓症患者经口内镜下肌切开术（POEM）预防性应用抗生素的有效性。方法计算机检索PubMed、Cochrane Library、ClinicalTrials.gov、Web of Science、Embase、中国知网、维普中文期刊服务平台、万方数据知识服务平台及中国生物医学文献数据库，筛选关于贲门失弛缓症患者POEM预防性应用抗生素治疗的随机对照研究或队列研究。对文献进行筛选、资料提取和质量评价后，采用RevMan 5.4软件进行Meta分析。结果共纳入6篇文献，共672例贲门失弛缓症患者。Meta分析结果显示，预防性应用抗生素并未缩短POEM术后患者住院时间，对不良事件发生率、抗生素使用时长、C反应蛋白水平升高、白细胞计数升高、发热、降钙素原水平升高及血培养阳性率无显著改善作用（P<0.05）。结论贲门失弛缓症患者POEM预防性应用抗生素并未显示出更优的临床效果，若无明确感染指征，不建议对此类患者常规预防性使用抗生素。

Objective To systematically evaluate the efficacy of prophylactic antibiotic administration in patients with esophageal achalasia undergoing peroral endoscopic myotomy (POEM). Methods Computerized searches were conducted in PubMed, Cochrane Library, ClinicalTrials.gov, Web of Science, Embase, China National Knowledge Infrastructure, VIP Chinese Journal Service Platform, Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database to screen randomized controlled trials or cohort studies on prophylactic antibiotic administration in patients with esophageal achalasia undergoing POEM. After literature screening, data extraction and quality assessment, meta-analysis was performed using RevMan 5.4 software. Results A total of 6 studies involving 672 patients with esophageal achalasia were included. The results of meta-analysis showed that prophylactic antibiotic administration did not shorten the length of hospital stay after POEM, and did not significantly reduce the incidence of adverse events, duration of antibiotic use, elevated C-reactive protein levels, elevated white blood cell count, fever, elevated procalcitonin levels, and positive blood culture rate (P<0.05). Conclusion Prophylactic antibiotic administration in patients with esophageal achalasia undergoing POEM did not demonstrate superior clinical efficacy. In the absence of definite infectious indications, routine prophylactic antibiotic use is not recommended for such patients.

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