摘要
目的探讨结直肠癌患者术后发生腹腔感染的危险因素。方法回顾性分析2011年10月至2014年12月期间于浙江省嘉兴市第一医院肿瘤外科行手术治疗且随访资料完整的773例结直肠癌患者的临床资料，并根据有无发生腹腔感染分为腹腔感染组（110例）和非腹腔感染组（663例）。所有患者均在手术前30min至2h预防性使用抗生素。通过单因素分析和多因素非条件Logistic回归分析结直肠癌患者术后发生腹腔感染的危险因素。结果与本组患者术后腹腔感染发生有关的术前因素包括：患者术前是否患有肝硬化、肾脏疾病、糖尿病等疾病．预防用药情况，是否存在低白蛋白血症、贫血和术前肠梗阻，美国麻醉医师协会麻醉分级（ASA）评分，肿瘤分期（均P〈0．05）；术后因素包括：手术是否使用腹腔镜、吻合器，是否为联合脏器切除，是否存在吻合口瘘，引流管置管时间，手术时间（均P〈0．05）。多因素logistic回归分析显示，术前患有糖尿病（OR=2．36，95％CI：1．45～4．76，P〈0．01）、联合脏器切除（OR=2．02，95％CI：1．02～4．00，P〈0．01）、发生吻合口瘘（OR：4．41，95％CI：1．77～10．99，P〈0．01）、手术时间≥140min（OR=2．88，95％CI：1．78～4．67，P〈0．001）以及术后引流管置管天数≥10d（OR=4．57，95％CI：2．78～7．52，P〈0．01）是结直肠癌患者术后发生腹腔感染的独立危险因素：而使用吻合器是患者发生腹腔感染的保护性因素（OR=0．37，95％CI：0．23。0．60，P〈0．01）。与预防性使用头霉素类加甲硝唑相比，预防性使用头孢呋辛加甲硝唑患者的腹腔感染率更高（OR=2．10，95％CI：1．23-3．58，P=0．007）。结论对术前患有糖尿病、手术中联合脏器切除、术后出现吻合口瘘、手术时间≥140min以及术后引流管置管天数≥10d的结直肠癌患者，需重点预防术后发生腹腔感染，术前使用头霉素类加甲硝唑对预防术后发生腹腔感染效果更好。
Objective To investigate the risk factors of intra-abdominal infection （IAI） after colorectal cancer surgery. Methods Clinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group （110 cases, IAI group） and non intra- abdominal infection group （663 cases, non-IAI group）. All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI. Results Preoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists （ASA）anesthetic grading score （all P 〈 0.05）. Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging （all P 〈 0.05）. Multivariate logistic regression analysis showed that preoperative diabetes （OR = 2.36, 95% CI： 1.45 to 4.76, P 〈 0.01）, combined exenteration （OR = 2.02, 95% CI：1.02 to 4.00, P 〈 0.01）, anastomotic leak （OR = 4.41, 95% CI：1.77 to 10.99, P= 0.001）, operation time ≥140 minutes （OR = 2.88, 95% CI： 1.78 to 4.67, P〈 0.01） and period of postoperative drainage ≥10 days （OR = 4.57, 95% CI：2.78 to 7.52, P 〈 0.01） were independent risk factors of postoperative IAI, while the use of stapler was protective factor （OR =0.37, 95% CI： 0.23 to 0.60, P 〈 0.01）. Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI（OR = 2.10, 95% CI： 1.23 to 3.58, P = 0.007）. Conclusions Prevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第4期409-413,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
结直肠肿瘤
腹腔感染
危险因素
Colorectal neoplasms
Intra-abdominal infection
Risk factors
