大腸癌術前処置のための経口投与抗菌薬に関する検討 投与抗菌薬の種類，期間に着目して

Abstract

大腸癌初回手術72症例を対象に,術前経口投与抗菌薬の組み合わせ別に5群に分け,手術終了時腹腔洗浄液中の菌検出率,検出菌種,術後手術野感染合併率と感染部検出菌種に着目し,prospectiveに検討した.OFLX (ofloxacin/600mg)とMTN (metronidazole/1g)の組み合わせ投与が手術終了時腹腔洗浄液中菌検出率,術後手術野感染合併例が少ない傾向にあったが,3日間投与によってグラム陽性球菌の検出率が増加した.次に直腸癌初回手術36症例を対象に,OFLX+MTNの術前投与日数別に4群に分け,同様の検討を行ったところ,術前1日投与が洗浄液中菌検出率が有意に低く,また術後手術野感染合併例も認めなかった.1日投与では腸管内の細菌検出率が抑えられ,特に菌種の乱れも認めなかった.以上より大腸癌手術例における化学的術前処置として,OFLX+MTNの1日経口投与が最も有効と考えられた.【EMD】Seventy-two patients with colorectal cancer were divided into 5 groups by combinations of antibiotics, and the culture of the peritoneal lavage fluid, positive rates, and postoperative infection in surgical fields were prospectively studied. OFLX+MTN was the best combination, because OFLX+MTN revealed the lowest rate in the lavage culture and no infection in surgical fields, but positive rates of gram-positive cocci increased by 3-day administration of the combination. Thirty-six patients with rectal cancer were divided into 4 groups and studied in the same manner. One-day administration was the best for preparation, because one-day administration revealed the lowest rate of the lavage culture and no infection in surgical fields. Oral administration of OFLX+ MTN for one day strongly suppressed the colonic mucosal bacterial flora, and imbalance of bacterial flora was not found. In conclusion, the prophylactic oral administration of OFLX (600 mg)+MTN (1 g) for one day is thought to be effective to prevent postoperative infection in surgical fields.