术后抗生素对减少牙拔除后继发口腔上颌窦交通一期手术关闭后并发症的效果：一项回顾性多中心研究。
The effect of postoperative antibiotics in reducing complications following primary surgical closure of oroantral communications secondary to tooth extraction: a retrospective multicenter study.
文献信息
| PMID | 42814174 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Melih M Bakacak |
| 作者单位 | Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands. |
| 期刊 | Clinical oral investigations |
| SCI 分区 | Q1 |
| IF | 3.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 上颌尖牙、前磨牙和磨牙拔除可能导致口腔上颌窦交通（OAC）。手术关闭旨在防止形成持续性口腔上颌窦瘘（OAF），从而降低上颌窦炎的风险。关于围手术期抗生素使用的获益尚无共识。本研究评估了牙拔除后OAC一期关闭术后抗生素对并发症的影响。
材料与方法： 通过回顾性审查2000年至2025年在Amsterdam UMC-VUmc和Amsterdam UMC-AMC接受OAC手术关闭患者的医疗记录，确定符合条件的患者。在这些患者中，评估了包括术后抗生素使用在内的各种暴露因素与总体并发症、感染性并发症和持续性OAF的关联。组间差异采用卡方检验和独立t检验评估，单变量和多变量关联采用逻辑回归评估（p < 0.05）。计算了需暴露获益人数（NNEB）和需暴露受害人数（NNEH）。
结果： 共确定725名可能符合条件的参与者，其中505名符合条件；308名（61.0%）为男性，251名（49.7%）接受了术后抗生素。总体并发症发生率为11.7%，感染性并发症为8.2%，持续性OAF为3.6%。术后抗生素使用与较少的总体并发症和感染性并发症以及较少的持续性OAF显著相关。（NNEB分别为6.9、6.9和21.4）。自身免疫性疾病和使用牙槽内止血剂与总体并发症增加相关。软组织（部分）阻生与感染性并发症风险增加相关。使用牙槽内止血剂和软组织（部分）阻生与持续性OAF风险增加相关。
结论： 牙拔除后OAC一期关闭术后使用抗生素与总体并发症、感染性并发症和持续性OAF风险降低相关。需要前瞻性研究来证实这些发现并指导抗生素使用。
临床相关性： 口腔保健专业人员应意识到术后抗生素在预防并发症方面的潜在益处。因此，对于有明显危险因素或非常希望获得顺利结局的患者，可以考虑抗生素预防。
英文摘要
OBJECTIVES: Maxillary canine, premolar and molar extractions may result in oroantral communication (OAC). Surgical closure aims to prevent the development of a persistent oroantral fistula (OAF), thereby reducing the risk of maxillary sinusitis. There is no consensus regarding the benefit of the use of perioperative antibiotics. This study evaluated the effect of postoperative antibiotics on complications after primary OAC closure following tooth extraction.
MATERIALS AND METHODS: Eligible patients were identified by retrospectively reviewing the medical records of patients who underwent surgical closure of an OAC at Amsterdam UMC-VUmc and Amsterdam UMC-AMC from 2000 to 2025. Among these patients, the associations of various exposures, including postoperative antibiotic use, with overall complications, infectious complications, and persistent OAF were assessed. Group differences were assessed using the chi-square and independent t-tests, while univariate and multivariable associations were assessed using logistic regression (p < 0.05). Number needed to be exposed to benefit (NNEB) and harm (NNEH) were calculated.
RESULTS: A total of 725 potentially eligible participants were identified, of whom 505 were eligible; 308 (61.0%) were male, and 251 (49.7%) received postoperative antibiotics. Overall complications occurred in 11.7%, infectious complications in 8.2%, and persistent OAF in 3.6%. Postoperative antibiotic use was significantly associated with fewer overall and infectious complications and fewer persistent OAFs. (NNEB 6.9, 6.9, and 21.4, respectively). Autoimmune disease and use of intra-alveolar hemostatic agent were associated with increased overall complications. Soft tissue (partial) impaction was associated with increased risk for infectious complications. Use of intra-alveolar hemostatic agent and soft tissue (partial) impaction were associated with increased risk for persistent OAF.
CONCLUSION: Postoperative antibiotic use after primary OAC closure following tooth extraction was associated with reduced risk of overall and infectious complications and persistent OAFs. Prospective studies are needed to confirm these findings and guide antibiotic use.
CLINICAL RELEVANCE: Oral healthcare professionals should be aware of the potential benefit of postoperative antibiotics in preventing complications. Therefore antibiotic prophylaxis could be considered in patients with obvious risk factors or if an uneventful outcome is highly desirable.