探讨影响肝切除术后手术部位感染（SSI）的临床因素。

回顾性分析2010年1月至2013年6月在中山大学孙逸仙纪念医院肝胆胰外科行肝切除术的72例患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男56例，女16例；年龄27~74岁，中位年龄55岁。根据患者有否发生SSI分为SSI组（6例）和无SSI组（66例），采集两组患者原发病、术前有否低蛋白血症、黄疸、糖尿病，术中出血量、肝切除范围、手术时间，术后抗生素应用时间等临床参数，分析影响SSI发生的临床参数。SSI发生与临床参数的关系采用χ²检验和Fisher确切概率法分析。

肝切除患者术后SSI的发生率为8%（6/72），其中腹腔感染3例，腹腔合并切口深部感染2例，切口深部感染1例。6例SSI患者原发病均为胆道疾病，其最常见的致病菌为大肠埃希菌。胆道疾病患者（P<0.05）及术前低蛋白血症患者（χ²=5.355，P<0.05）容易发生SSI。SSI的发生与术后抗生素应用时间（≤48 h和>48 h）无关（P>0.05）。

胆道原发病和术前低蛋白血症是肝切除患者术后发生SSI的危险因素，肝切除术前应尽可能纠正低蛋白血症。应用抗生素可预防肝切除患者发生SSI，术后48 h内停用抗生素是安全的。

To investigate the clinical risk factors for surgical site infection (SSI) after hepatectomy.

Clinical data of 72 patients who underwent hepatectomy in Department of Hepato-Pancreato-Biliary, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2010 to June 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 56 males and 16 females with the age of 27 to 74 years old and the median age of 55 years old. According to whether the patients suffered SSI or not, they were divided into SSI group (n=6) and non-SSI group (n=66). Clinical parameters of patients in two groups such as primary disease, hypoproteinemia before operation, jaundice, diabetes, intraoperative blood loss, range of hepatic resection, operation duration, and time of antibiotic usage after operation were collected, and clinical risk factors for SSI were analyzed. The relationship between the incidence of SSI and clinical parameters was analyzed using Chi-square test and Fisher′s exact test.

The incidence of SSI after hepatectomy was 8% (6/72), in which 3 patients developed intra-abdominal infection, 2 patients developed combined intra-abdominal and deep incisional infection, and 1 patient developed deep incisional infection. The primary diseases of 6 SSI patients were all biliary tract diseases. The most common pathogenic bacterium was Escherichia coli. Patients with biliary tract disease (P<0.05) or hypoproteinemia before operation (χ²=5.355, P<0.05) developed SSI more easily. The incidence of SSI had no correlation with the time of antibiotic usage after operation (≤48 h and >48 h) (P>0.05).

Primary disease of biliary tract and hypoproteinemia before operation are risk factors for patients to develop SSI after hepatectomy. Hypoproteinemia should be remedied as far as possible before hepatectomy. Use of antibiotics can prevent SSI in patients undergoing hepatectomy. It is safe to cease antibiotics within 48 h after hepatoectmy.