胆道闭锁Kasai肝门空肠吻合术后使用抗生素预防胆管炎的系统综述OA北大核心CSTPCD

Objective To evaluate the effectiveness of oral and intravenous antibiotics in preventing cholangitis after Kasai portoenterostomy(KP)in biliary atresia(BA)patients.Methods Literature searches were conducted in five databases,including PubMed,Web of Science,EMBASE,Cochrane,and Clinical Trials,with the cutoff date being March 18,2024.Search terms included"biliary atresia","bile duct abnormalities","portoenterostomy",and"anti-bacterial agents"etc.The primary outcome measured was the incidence of cholangitis,while secondary outcomes included native liver survival rate and jaundice clearance rate.Results Ten studies met the inclusion and exclusion criteria,with 6 involving oral antibiotics and 4 involving intravenous antibiotics post-surgery,encompassing a total of 991 patients.Some studies supported the preventive role of oral antibiotics against cholangitis;one study indicated a significantly lower incidence of cholangitis in the antibiotic group compared to the non-antibiotic group(15％vs.57％,P＜0.05),and another showed a low-er incidence(50％vs.77％),although the difference was not statistically significant(P＞0.05).Most studies did not find significant differences in cholangitis incidence,native liver survival rate,or jaundice clearance rate.Three studies reported that prolonged postoperative intravenous antibiotics use had no significant effect on cholangitis incidence at six months or beyond,jaundice clearance rate,or native liver survival rate(P＞0.05),but it may reduce the incidence of cholangitis at 1 month post-surgery(24％vs.39％,P＜0.05).Conclu-sions More high-quality research is needed to confirm the effectiveness of oral and intravenous antibiotics in preventing postoperative cholangitis.Further studies are urgently needed.