食管癌胸腹腔镜术后医院感染病原学特点及PCT与CRP和外周血T淋巴细胞亚群表达研究
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摘要
目的探讨食管癌胸腹腔镜术后医院感染病原学特点,分析患者血清降钙素原(PCT)、C-反应蛋白(CRP)和外周血T淋巴细胞亚群指标变化情况,旨在为临床预防和治疗术后感染提供参考。方法选择医院于2012年1月-2017年10月收治的食管癌患者693例为研究对象,分析术后医院感染发生情况。采集感染患者相关临床样本进行病原菌的分离与鉴定。分析感染与未感染患者血清PCT、CRP和外周血T淋巴细胞亚群变化情况。结果 693例食管癌行胸腹腔镜患者术后发生医院感染28例,感染率为4.04%,28例感染患者中,吻合口瘘性脓胸17例占60.72%,呼吸道8例占28.57%,切口3例占10.71%;感染患者共分离培养病原菌41株,主要以革兰阴性菌为主,26株占63.41%,主要为铜绿假单胞菌和大肠埃希菌;感染组患者血清PCT和CRP水平高于未感染组,两组比较差异有统计学意义(P<0.05);感染组患者T淋巴细胞亚群CD3+、CD4+和CD4+/CD8+水平低于未感染组,且有统计学差异(P<0.05)。结论食管癌电视胸腹腔镜术后医院感染病原菌以革兰阴性菌为主,术后感染患者血清PCT和CRP水平升高,免疫功能下降。
OBJECTIVE To explore the etiological characteristics of postoperative nosocomial infection in esophageal cancer patients undergoing thoracic laparoscopic surgery and analyze the changes of serum procalcitonin(PCT),C-reactive protein(CRP)and peripheral blood T lymphocyte subsets so as to provide guidance for clinical prevention and treatment of the postoperative infection.METHODS A total of 693 esophageal cancer patients who were treated in hospitals from Jan 2012 to Oct 2017 were recruited as the study objects,the incidence of postoperative nosocomial infection was analyzed,the related clinical specimens were collected from the patients with infection,the pathogens were isolated and identified.The levels of serum PCT,CRP and peripheral blood T lymphocyte subsets were observed and compared between the patients with infection and the patients without infection.RESULTS Of the 693 esophageal cancer patients who underwent the thoracis laparoscopic surgery,28 had postoperative nosocomial infection,with the infection rate 4.04%.Of the 28 patients with infection,17(60.72%)had anastomotic fistula,8(28.57%)had respiratory tract infection,and 3(10.71%)had incision infection.Totally 41 strains of pathogens were isolated from the patients with infection,26(63.41%)of which were gram-negative bacteria;Pseudomonas aeruginosa and Escherichia coli were the predominant species.The levels of serum PCT and CRP of the infection group were significantly higher than those of the non-infection group P<0.05);the levels of T lymphocyte subsets CD3+,CD4+and ratio of CD4+to CD8+were significantly lower in the infection group than in the non-infection group(P<0.05).CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative nosocomial infection in the esophageal cancer patients undergoing the thoracis laparoscopic surgery,the levels of serum PCT and CRP of the patients with postoperative infection are elevated,and the immune function declines.
OBJECTIVE To explore the etiological characteristics of postoperative nosocomial infection in esophageal cancer patients undergoing thoracic laparoscopic surgery and analyze the changes of serum procalcitonin(PCT),C-reactive protein(CRP)and peripheral blood T lymphocyte subsets so as to provide guidance for clinical prevention and treatment of the postoperative infection.METHODS A total of 693 esophageal cancer patients who were treated in hospitals from Jan 2012 to Oct 2017 were recruited as the study objects,the incidence of postoperative nosocomial infection was analyzed,the related clinical specimens were collected from the patients with infection,the pathogens were isolated and identified.The levels of serum PCT,CRP and peripheral blood T lymphocyte subsets were observed and compared between the patients with infection and the patients without infection.RESULTS Of the 693 esophageal cancer patients who underwent the thoracis laparoscopic surgery,28 had postoperative nosocomial infection,with the infection rate 4.04%.Of the 28 patients with infection,17(60.72%)had anastomotic fistula,8(28.57%)had respiratory tract infection,and 3(10.71%)had incision infection.Totally 41 strains of pathogens were isolated from the patients with infection,26(63.41%)of which were gram-negative bacteria;Pseudomonas aeruginosa and Escherichia coli were the predominant species.The levels of serum PCT and CRP of the infection group were significantly higher than those of the non-infection group P<0.05);the levels of T lymphocyte subsets CD3+,CD4+and ratio of CD4+to CD8+were significantly lower in the infection group than in the non-infection group(P<0.05).CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative nosocomial infection in the esophageal cancer patients undergoing the thoracis laparoscopic surgery,the levels of serum PCT and CRP of the patients with postoperative infection are elevated,and the immune function declines.
引文
[1] Zhou S,Song Y,Liu L,et al.Optimized total thoracoscopic and laparoscopic esophagectomy for esophageal cancer[J].World J Surg Oncol,2016,14(1):1-6.
[2] Lin J,Kang M,Chen S,et al.Feasibility and strategy for left tracheobronchial lymph node dissection in thoracolaparoscopic esophageal cancer surgery[J].Thorac Cancer,2016,7(2):199-206.
[3] Mao T,Fang W,Gu Z,et al.Comparison of perioperative outcomes between open and minimally invasive esophagectomy for esophageal cancer[J].Thorac Cancer,2015,6(3):303-306.
[4]余鑫,刘懿,杜铭,等.电视胸腹腔镜联合食管癌切除术38例临床分析[J].中国胸心血管外科临床杂志,2015,14(5):467-470.
[5] Huang HT,Wang F,Shen L,et al.Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer[J].World J Surg Oncol,2015,13(1):310.
[6]中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
[7]高炳玉,吴毓优,刘玉,等.完全胸腹腔镜联合McKeown根治术治疗食管癌的近期疗效观察[J].海南医学,2016,27(15):2463-2465.
[8]魏书庆,宋永明,李东亮,等.胸腹腔镜与开放式颈胸腹联合三切口食管癌切除术效果比较[J].肿瘤研究与临床,2017,29(8):532-535.
[9]韩金利,杨冉,杨晓虹,等.CRP联合多种血清肿瘤标志物检测在食管癌诊断及病情评估中的临床价值[J].国际医药卫生导报,2015,21(16):2452-2454.
[10]张伟,于在诚.食管癌患者不同术式围手术期细胞免疫与体液免疫的监测分析[J].广东医学,2015,6(10):1545-1547.
[2] Lin J,Kang M,Chen S,et al.Feasibility and strategy for left tracheobronchial lymph node dissection in thoracolaparoscopic esophageal cancer surgery[J].Thorac Cancer,2016,7(2):199-206.
[3] Mao T,Fang W,Gu Z,et al.Comparison of perioperative outcomes between open and minimally invasive esophagectomy for esophageal cancer[J].Thorac Cancer,2015,6(3):303-306.
[4]余鑫,刘懿,杜铭,等.电视胸腹腔镜联合食管癌切除术38例临床分析[J].中国胸心血管外科临床杂志,2015,14(5):467-470.
[5] Huang HT,Wang F,Shen L,et al.Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer[J].World J Surg Oncol,2015,13(1):310.
[6]中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
[7]高炳玉,吴毓优,刘玉,等.完全胸腹腔镜联合McKeown根治术治疗食管癌的近期疗效观察[J].海南医学,2016,27(15):2463-2465.
[8]魏书庆,宋永明,李东亮,等.胸腹腔镜与开放式颈胸腹联合三切口食管癌切除术效果比较[J].肿瘤研究与临床,2017,29(8):532-535.
[9]韩金利,杨冉,杨晓虹,等.CRP联合多种血清肿瘤标志物检测在食管癌诊断及病情评估中的临床价值[J].国际医药卫生导报,2015,21(16):2452-2454.
[10]张伟,于在诚.食管癌患者不同术式围手术期细胞免疫与体液免疫的监测分析[J].广东医学,2015,6(10):1545-1547.