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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 40 -43. doi: 10.3877/cma.j.issn.2095-3232.2018.01.011

所属专题： 文献；

临床研究

不包括胆囊切除的开腹胆道手术后手术部位感染的危险因素分析
蔡文昌1, 沈伟峰2, 张蕾3, 赵一军1, 杨甲梅1,†()   
  1. 1. 200082　上海，东方肝胆外科医院特需治疗一科；200082　上海，东方肝胆外科医院肝移植科
    3. 200082　上海，东方肝胆外科医院感染控制科
  • 收稿日期:2017-11-01 出版日期:2018-02-10
  • 通信作者: 杨甲梅

Risk factors for surgical site infection in patients after open biliary surgery excluding cholecystectomy

Wenchang Cai1, Lei Zhang2, Yijun Zhao3, Weifeng Shen1, Jiamei Yang1,†()   

  1. 1. Department I of Special Medical Care, Eastern Hepatobiliary Surgery Hospital, Shanghai 200082, China; Department of Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Shanghai 200082, China
    2. Department of Infection Control, Eastern Hepatobiliary Surgery Hospital, Shanghai 200082, China
  • Received:2017-11-01 Published:2018-02-10
  • Corresponding author: Jiamei Yang
  • About author:
    Corresponding author: Yang Jiamei, Email:
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蔡文昌, 沈伟峰, 张蕾, 赵一军, 杨甲梅. 不包括胆囊切除的开腹胆道手术后手术部位感染的危险因素分析[J]. 中华肝脏外科手术学电子杂志, 2018, 07(01): 40-43.

Wenchang Cai, Lei Zhang, Yijun Zhao, Weifeng Shen, Jiamei Yang. Risk factors for surgical site infection in patients after open biliary surgery excluding cholecystectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(01): 40-43.

目的

探讨不包括胆囊切除的开腹胆道手术后手术部位感染（SSI）的危险因素。

方法

回顾性分析2015年4月至5月在东方肝胆外科医院行不包括胆囊切除的开腹胆道手术的241例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男109例，女132例；年龄24～77岁，中位年龄58岁。收集患者一般资料，观察患者有否发生SSI。采用Logistic回归分析患者发生SSI的相关危险因素，并总结其预防措施。

结果

患者术后SSI发生率为8.3%（20/241）。发生时间均在术后1～14 d，中位时间为术后4 d。发生部位主要包括腹腔10例，胆道8例，切口2例。20例SSI患者中，15例为细菌感染，1例为真菌感染，4例未培养到细菌。Logistic回归多因素分析结果显示，胆肠吻合术、术前WBC>10×109/L和引流管留置时间>8 d是患者术后SSI的独立危险因素（OR=0.332，0.177，0.235；P<0.05）。

结论

不包括胆囊切除的开腹胆道手术后SSI的发生与胆肠吻合术、胆管炎症及术后引流密切相关。术前有效控制胆管炎症，术后确保引流通畅，对预防胆道术后SSI的发生具有重要意义。

关键词: 胆道外科手术, 手术部位感染, 危险因素
Objective

To explore the risk factors for surgical site infection (SSI) in patients after open biliary surgery excluding cholecystectomy.

Methods

Clinical data of 241 patients who underwent open biliary surgery excluding cholecystectomy in Eastern Hepatobiliary Surgery Hospital between April and May 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 109 males and 132 females, aged from 24 to 77 and with a median age of 58 years old. General data of the patients were collected and SSI was observed. Related risk factors for SSI of the patients were analyzed using logistic regression, and the preventive treatments were summarized.

Results

The incidence of postoperative SSI was 8.3% (20/241). All SSI occurred on postoperative 1-14 d, with a median of 4 d. There were 10 cases whose SSI occurred at the abdomen, 8 cases at the biliary tract and 2 at the incision. Among the 20 cases with SSI, 15 cases suffered from bacterial infection, 1 case suffered from fungal infection and no bacteria was cultured in 4 cases. Multi-factor logistic regression analysis results showed that choledochojejunostomy, preoperative WBC >10×109/L and drainage tube indwelling time >8 d were the independent risk factors for SSI of these patients (OR=0.332, 0.177, 0.235; P<0.05).

Conclusions

SSI of patients with open biliary surgery excluding cholecystectomy is closely related to choledochojejunostomy, bile duct inflammation and postoperative drainage. It is of great significance to effectively control bile duct inflammation and ensure postoperative unobstructed drainage in preventing SSI after biliary surgery.

Key words: Biliary tract surgical procedures, Surgical site infection, Risk factors
表1 不包括胆囊切除的开腹胆道手术患者术后SSI的Logistic回归分析结果
临床参数 例数 数值 单因素分析 多因素分析
OR（95%CI） P值 OR（95%CI） P值
年龄（岁，±s） 241 57±12 1.001(0.963～1.041) 0.962 - -
术中出血量 241 200(10～2 000) 1.001(1.000～1.002) 0.150 - -
手术时间（min，±s） 241 176±72 1.004(0.998～1.010) 0.240 - -
术前Hb（g/L，±s） 241 129±16 0.992(0.965～1.019) 0.549 - -
术前ALB（g/L，±s） 241 41±4 0.940(0.844～1.047) 0.259 - -
术中输血量 241 0(0～6 500) 1.001(1.000～1.001) 0.005 1.000(0.999～1.000) 0.065
性别男 109 - 1.010(0.403～2.534) 0.983 - -
有吸烟史 49 - 1.023(0.326～3.209) 0.969 - -
有糖尿病史 24 - 2.207(0.282～17.260) 0.451 - -
二次手术史 63 - 0.630(0.240～1.659) 0.350 - -
未合理加用抗生素a 80 - 0.464(0.185～1.165) 0.102 - -
胆管结石 121 - 1.569(0.618～3.998) 0.344 - -
使用二代头孢类抗生素b 219 - 0.501(0.064～3.930) 0.511 - -
胆肠吻合术 71 - 0.305(0.120～0.772) 0.012 0.332(0.115～0.960) 0.042
术前WBC>10×109/L 13 - 0.170(0.047～0.612) 0.019 0.177(0.042～0.749) 0.030
术前TB>34 μmol/L 58 - 0.348(0.137～0.888) 0.027 0.758(0.253～2.274) 0.622
术后并发症c 28 - 0.348(0.116～1.047) 0.060 - -
引流管留置时间>8 d 36 - 0.133(0.051～0.351) <0.001 0.235(0.081～0.680) 0.008
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