胆石症患者胆道手术局部感染的危险因素  

Risk factors of surgical site infections for patients with cholelithiasis after biliary tract surgery

作　　者：王宏[1] 吴小荣[1] 李虎山[1] 肖怀忠[1] 杨明[1] 罗建管 周健[1] 

机构地区：[1]湖南省浏阳市人民医院肝胆外科,410300

出　　处：《中华肝胆外科杂志》2016年第5期304-307,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：浏阳市名医工作室支撑项目

摘　　要：目的分析胆石症患者胆道手术后局部感染（SSIs）发生的相关危险因素。方法2010年4月至2015年4月，长沙医学院附属浏阳医院肝胆外科共有712例胆石症患者行胆道手术，术后发生SSIs共计106例。对SSIs相关危险因素进行单因素和多因素分析。分别分析各因素对SSIs的三种类别（浅部切口感染、深部切口感染和腔隙感染）的影响。对SSIs患者与非SSIs患者住院费用、总住院天数以及住院超过30d的感染发生情况进行比较。结果单因素分析表明，合并糖尿病、急诊手术、再次胆探、术中行肝切除术、术中胆汁培养阳性、术中阻断第一肝门、Ⅱ-Ⅳ期肝内胆管结石、ASA评分3级、BMI〉30、肝功能B级和入院时白蛋白〈30g／L与SSIs密切相关（P〈0．05）。急诊手术、再次胆探、术中行肝切除术、手术时间超过3h、术中阻断第一肝门、ASA评分、吸烟以及入院时白蛋白水平对SSIs的三种分类具有差异性影响（P〈0．05）。发生SSIs患者的总住院费用、总住院天数以及超过30d的患者例数，较非SSIs患者明显升高（均P〈0．05）。对发生SSIs的患者进行多因素非条件Logistic回归分析显示，行肝切除术、术中胆汁培养阳性、Ⅱ-Ⅳ期肝内胆管结石和再次胆道探查是胆石症术后SSIs发生的独立危险因素（P〈0．05）。结论胆石症患者术后发生SSIs是围手术期多因素作用的结果。行肝切除术、术中胆汁培养阳性、Ⅱ-Ⅳ期肝内胆管结石和再次胆道探查是胆石症术后SSIs发生的独立危险因素。Objective To identify the independent risk factors of surgical site infections （SSIs） for patients with cholelithiasis after biliary tract surgery. Methods 712 patients were enrolled from April 2010 to April 2015 in this study and their clinical data were retrospectively analyzed. There were 106 patients who developed SSIs. The risk factors of SSIs and their three subtypes （ superficial incisional SSIs, deep incisional SSIs, and organ/space SSIs） were analyzed. The total hospitalization cost, length of hospitalization and pa- tients who stayed over 30 days in hospital were compared between the group of patients with and without SSIs. Results Univariate analysis showed that SSIs were associated with diabetes, emergency operation, bile duct re-exploration, hepatectomy, positive bile bacteria culture, porta hepatis clamping, Ⅱ-Ⅳ grades of cholelithiasis, ASA Grade 3, BMI 〉 30, hepatic function Grade B and protein level 〈 30 g/L on hospital admission （ all P 〈 0.05 ）. The results also indicated that superficial incisional SSIs, deep incisional SSIs and organ/space SSIs were correlated with emergency operation, bile duct re-exploration, hepatectomy, operation time, porta hepatis clamping, smoking, ASA score and protein level on hospital admission （ all P 〈 0.05）. The total hospitalization expense, length of hospital stay and the number of patients hospitalized for over 30 days in the SSIs Group were significantly more than the non-SSIs Group （ all P 〈 0.05 ）. Bile duct re-exploration, hepatectomy, positive bile bacteria culture and Ⅱ-Ⅳ grades of cholelithiasis were inde- pendent risk factors of SSIs on multivariate unconditional logistical regression analysis （ all P 〈 0.05 ）. Conclusions Multiple factors in the perioperative period were involved in SSIs after bile duct surgery. Bile duct re-exploration, hepatectomy, positive bile bacteria culture and lI - IV grades of cholelithiasis were independent risk factors of SSIs.

关 键 词：胆石症 胆道手术 术后 手术部位感染 

分 类 号：R657.4[医药卫生—外科学]