结直肠ESD术后使用抗生素的临床应用价值

Clinical Value of Antibiotic Prophylaxis after Colorectal ESD

摘要: 结直肠内镜黏膜下剥离术(ESD)术后感染的总体发生率较低，但仍有感染风险。而关于术后预防性使用抗生素目前全球指南尚未达成统一共识，其中西方指南多持谨慎态度，而部分亚洲指南仅建议针对高危人群用药。这种差异主要是由于临床医师对感染风险分层及抗生素使用的认知存在分歧。本文旨在系统梳理结直肠ESD术后感染风险及预防性抗生素的应用现状。通过分析指南分歧与研究证据，重点探讨了用药条件、时机选择及核心争议，特别是早期研究与最新高质量多中心研究之间的矛盾。在此基础上，提出“基于高危因素的个体化管理”策略，为临床决策提供参考。

Abstract: The overall incidence of postoperative infection after colorectal endoscopic submucosal dissection (ESD) is low, yet infection risk still exists. Currently, there is no universal consensus among global guidelines regarding prophylactic antibiotic use after surgery. Most Western guidelines adopt a cautious stance, while some Asian guidelines only recommend antibiotic prophylaxis for high-risk populations. Such divergence mainly stems from disagreements among clinicians on infection risk stratification and the rationale for antibiotic administration. This article systematically reviews the infection risk following colorectal ESD and the current status of prophylactic antibiotic application. By analyzing guideline discrepancies and research evidence, it focuses on the indications, timing, and core controversies of antibiotic use, especially the contradictions between early studies and the latest high-quality multicenter trials. On this basis, an individualized management strategy based on high-risk factors is proposed to provide references for clinical decision-making.