肝内胆管结石手术切口感染的危险因素分析  

Risk factors for surgical incision infections in patients with hepatolithiasis

作　　者：李乔林[1] 胡从兵[1] 胡剑飞[1] 彭滔[1] 邓黎[1] 

机构地区：[1]荆州市第一人民医院普外科,湖北荆州434000

出　　处：《中华医院感染学杂志》2016年第9期2059-2060,2078,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅科研基金资助项目(JX6b46)

摘　　要：目的目的探讨肝内胆管结石(HIS)患者术后切口感染的相关危险因素,为临床有效降低术后感染提供依据。方法选取医院2012年1月-2015年1月行手术治疗的HIS患者58例,将其分为两组,试验组20例、对照组38例;试验组患者术中选择恰当抗菌药物进行预防性应用,选择一次性保护器对切口进行全层保护,采用可吸收缝线抗菌微乔将患者前鞘层以及腹膜进行缝合,对照组患者进行常规处理;比较试验组和对照组患者术后切口感染情况、治疗费用以及住院时间等。结果试验组切口感染率、使用抗菌药物时间<5d患者比率、引流管放置时间、住院时间以及治疗费用分别为15.0%、35.0%、(4.3±3.9)d、(5.3±2.1)d、(2.9±0.4)万元,对照组分别为34.2%、13.2%、(8.4±4.9)d、(10.3±5.9)d、(4.1±0.2)万元,两组比较差异均有统计学意义(P<0.05);单因素分析结果显示,合并糖尿病、术前胆管炎、胆道手术史、手术时间以及引流管拔除时间与HIS患者术后切口感染的发生具有相关性(P<0.05);多因素logistic回归分析结果显示,胆道手术史、合并糖尿病及引流管拔除时间是导致HIS患者术后切口感染的危险因素(P<0.05)。结论胆道手术史、合并糖尿病以及术后引流管延迟拔除是导致HIS患者术后切口感染的独立危险因素,术中应积极采取有效预防措施,以降低术后切口感染的发生。OBJECTIVE To explore the related risk factors for postoperative incision infections in the patients with hepatolithiasis（HIS）so as to effectively reduce the incidence of the postoperative infections.METHODS A total of58 HIS patients who received surgical procedures in the hospital from Jan 2012 to Jan 2015 were enrolled in the study and divided into the experimental group with 20 cases and the control group with 38 cases.The experimental group was treated with antibiotics prophylaxis during the surgery,the disposable protection device was used for the full-layer protection of incisions,and the anterior sheath and peritonea were sutured by using absorbable suture material antibacterial vicryl;the control group was given the conventional treatment.The incidence of postoperative incision infections,treatment cost,and length of hospital stay were observed and compared between the experimental group and the control group.RESULTS The incidence rate of incision infections was 15.0%in the experimental group,34.2%in the control group;the ratio of the patients who used antibiotics for less than 5days was 35.0%in the experimental group,13.2%in the control group;the time of placement of drainage tube was（4.3±3.9）days in the experimental group,（8.4±4.9）days in the control group;the length of hospital stay was（5.3±2.1）days in the experimental group,（10.3±5.9）days in the control group;the treatment cost was（29±4）thousand yuan in the experimental group,（41±2）thousand yuan in the control group,and there was significant difference between the two groups（P〈0.05）.The univariate analysis showed that the incidence of the postoperative incision infections in the HIS patients was associated with the complication of diabetic mellitus,preoperative cholangitis,history of biliary tract surgery,operation duration,and time of removal of drainage tube（P〈0.05）.The multivariate logistic regression analysis indicated that the history of biliary tract surgery,complication of diabetic mellitus,and time

关 键 词：肝内胆管结石 危险因素 切口感染 

分 类 号：R657.42[医药卫生—外科学]