结直肠癌合并肠梗阻术后切口病原菌及危险因素观察
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摘要
目的探讨结直肠癌合并肠梗阻术后切口病原菌及危险因素。方法回顾性分析2013年1月～2018年4月在廉江市人民医院普通外科治疗的结直肠癌合并肠梗阻患者151例。查阅统计病原微生物鉴定结果,根据是否发生切口感染将患者分为感染组和非感染组,采用多因素Logistic回归分析其独立危险因素。结果感染的发生率为19.87%(30例),一共检出52株病原微生物,其中革兰阴性菌、革兰阳性菌和真菌分别占57.695%(30株),34.62%(18株)和7.69%(4株)。多因素Logistic回归分析显示糖尿病(OR=5.861,95%CI=1.705～20.153,P=0.005)、行支架植入一期吻合术(OR=0.084,95%CI=0.022～0.330,P=0.000)、术中低血压(OR=3.844,95%CI=1.103～13.396,P=0.035)与切口感染关系密切。结论直肠癌合并肠梗阻术后切口的病原菌众多,糖尿病和术中低血压是切口感染的独立危险因素,而行支架植入一期吻合术则是保护因素。
Objective To explore postoperative incision pathogenic bacteria and risk factors in colorectal cancer complicated with intestinal obstruction. Methods 151 patients with colorectal cancer complicated with intestinal obstruction received in General Surgery of Lianjiang People's Hospital during January 2013 to April 2018 were collected as the subjects.After checking the statistical identification results of pathogenic microorganisms,the patients were divided into the infected group and the non-infected group depending on whether or not incision infection occurs.Multivariate Logistic regression was used to analyze the independent risk factors. Results The incidence rate of infection was 19.87%(30 cases).A total of 52 strains of pathogenic microorganisms were detected,among which the gram-negative bacteria,gram-positive bacteria and fungi accounted for 57.695%(30 strains),34.62%(18 strains) and 7.69%(4 strains),respectively.Diabetes(OR=5.861,95%CI=1.705-20.153,P=0.005),stent implantation performed with one-stage anastomosis(OR=0.084,95%CI=0.022-0.330,P=0.000) and intraoperative hypotension were closely related to incision infection with Multivariate Logistic regression analysis. Conclusion Postoperative incision of rectal cancer complicated with intestinal obstruction has many pathogenic bacteria.Diabetes mellitus and intraoperative hypotension are independent risk factors for incision infection,while primary stenting is a protective factor.
Objective To explore postoperative incision pathogenic bacteria and risk factors in colorectal cancer complicated with intestinal obstruction. Methods 151 patients with colorectal cancer complicated with intestinal obstruction received in General Surgery of Lianjiang People's Hospital during January 2013 to April 2018 were collected as the subjects.After checking the statistical identification results of pathogenic microorganisms,the patients were divided into the infected group and the non-infected group depending on whether or not incision infection occurs.Multivariate Logistic regression was used to analyze the independent risk factors. Results The incidence rate of infection was 19.87%(30 cases).A total of 52 strains of pathogenic microorganisms were detected,among which the gram-negative bacteria,gram-positive bacteria and fungi accounted for 57.695%(30 strains),34.62%(18 strains) and 7.69%(4 strains),respectively.Diabetes(OR=5.861,95%CI=1.705-20.153,P=0.005),stent implantation performed with one-stage anastomosis(OR=0.084,95%CI=0.022-0.330,P=0.000) and intraoperative hypotension were closely related to incision infection with Multivariate Logistic regression analysis. Conclusion Postoperative incision of rectal cancer complicated with intestinal obstruction has many pathogenic bacteria.Diabetes mellitus and intraoperative hypotension are independent risk factors for incision infection,while primary stenting is a protective factor.
引文
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[15]胡德升,董星,杨松鹏,等.术前营养不良对结直肠癌患者术后感染及免疫功能的影响[J].中华医院感染学杂志,2017,27(24):5626-5629.
[16]张娟,李洁,周超熙,等.结肠癌术后切口感染的影响因素分析[J].中国病原生物学杂志,2015(12):1140-1143.
[17]Li YX,Zhang L,Simayi D,et al.Human papillomavirus infection correlates with inflammatory Stat3 signaling activity and IL-17 level in patients with colorectal cancer[J].PLoS One,2015,10(2):e0118391.
[18]祝保玺,徐艺可,阿不都外力·吾守尔,经内镜结肠支架置入后再行手术与急诊手术治疗梗阻性左半结肠癌的Meta分析[J].中国普通外科杂志,2014,23(4):436-441.
[19]卢清平,兰启龙,陈龙,等.内镜下金属支架联合择期腹腔镜手术在梗阻性结直肠癌中的应用[J].中华胃肠外科杂志,2017,20(6):684-688.
[20]王少勇,张忠民,黄进堂,等.结直肠癌患者手术部位感染病原菌与耐药性研究[J].中华医院感染学杂志,2015(15):3434-3436.
[2]林国辉,李燕萍,张思宇.Hartmann术及回肠袢式造口术治疗老年梗阻性肠癌的疗效分析[J].中国普通外科杂志,2017,26(10):1360-1364.
[3]林木本,孙相钊,陈宗梅,等.支架联合腹腔镜Ⅰ期吻合术治疗左结直肠癌合并肠梗阻的应用研究[J].中国医药科学,2017,7(8):196-198.
[4]Frago R,Ramirez E,Millan M,et al.Current management of acute malignant large bowel obstruction:a systematic review[J].Am J Surg,2014,207(1):127-138.
[5]卢清平,兰启龙,陈龙,等.内镜下金属支架联合择期腹腔镜手术在梗阻性结直肠癌中的应用[J].中华胃肠外科杂志,2017,20(6):684-688.
[6]项海,项秉该,林振亮,等.结肠癌合并肠梗阻患者急诊术后切口感染的病原学与危险因素分析[J].中华医院感染学杂志,2017,27(5):1109-1112.
[7]张宏,崔明明,范明.腹腔镜结直肠癌术后切口感染的影响因素分析[J].中国普通外科杂志,2014,23(10):1444-1446.
[8]金海波,陈永胜,王德华,等.结肠癌伴肠梗阻患者术后切口感染的病原菌分布及相关因素分析[J].中华医院感染学杂志,2018,28(13):1994-1997.
[9]郑晖,池畔,林惠铭,等.结直肠癌术后手术部位切口感染的预后因素分析[J].中华外科杂志,2016,54(6):424-428.
[10]徐海东,孙子雯,肖瑞雪,等.我国结直肠癌患者术后切口感染发生情况及其影响因素、病原菌分布[J].山东医药,2017,57(29):68-71.
[11]Edwards JP,Ho AL,Tee MC,et al.Wound protectors reduce surgical site infection:a meta-analysis of randomized controlled trials[J].Ann Surg,2012,256(1):53-59.
[12]任承纲,刘丹,李艳红,等.老年结直肠癌患者手术部位感染及相关因素分析[J].中国感染与化疗杂志,2016,16(4):424-428.
[13]黄新玲,郑丽英,何文英,等.肥胖对结直肠癌手术部位感染的影响[J].中国感染控制杂志,2015,14(12):837-839.
[14]吕保良,刘新江,潘玲,等.肠内营养混悬液对结直肠癌患者术后感染及免疫功能的影响研究[J].中华医院感染学杂志,2017,27(21):4953-4956.
[15]胡德升,董星,杨松鹏,等.术前营养不良对结直肠癌患者术后感染及免疫功能的影响[J].中华医院感染学杂志,2017,27(24):5626-5629.
[16]张娟,李洁,周超熙,等.结肠癌术后切口感染的影响因素分析[J].中国病原生物学杂志,2015(12):1140-1143.
[17]Li YX,Zhang L,Simayi D,et al.Human papillomavirus infection correlates with inflammatory Stat3 signaling activity and IL-17 level in patients with colorectal cancer[J].PLoS One,2015,10(2):e0118391.
[18]祝保玺,徐艺可,阿不都外力·吾守尔,经内镜结肠支架置入后再行手术与急诊手术治疗梗阻性左半结肠癌的Meta分析[J].中国普通外科杂志,2014,23(4):436-441.
[19]卢清平,兰启龙,陈龙,等.内镜下金属支架联合择期腹腔镜手术在梗阻性结直肠癌中的应用[J].中华胃肠外科杂志,2017,20(6):684-688.
[20]王少勇,张忠民,黄进堂,等.结直肠癌患者手术部位感染病原菌与耐药性研究[J].中华医院感染学杂志,2015(15):3434-3436.