直肠癌患者术后感染与手术方式的相关性研究  

Correlation analysis on postoperative infection and surgical method in patients with rectal cancer

作　　者：张天明[1] 杜金林[1] 钟志风 戴志慧[1] 王庆华[1] 戴剑[1] 

机构地区：[1]金华市中心医院结直肠肛门外科,浙江金华321000

出　　处：《中华医院感染学杂志》2016年第16期3757-3759,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2012130)

摘　　要：目的分析不同手术方式对直肠癌术后感染患者病原菌分布与免疫因子水平的影响,为制定临床治疗方案提供客观依据。方法选取2012年1月-2014年1月120例直肠癌患者作为研究对象,根据其手术方式不同将其分为开腹手术组58例和腹腔镜手术组62例,对两组患者的病原菌分布及手术前、后免疫因子水平进行观察和比较,数据采用SPSS 17.0软件进行统计分析。结果开腹手术组患者共分离出病原菌53株,以革兰阴性菌为主,共32株占60.4%;腹腔镜手术组患者共分离出病原菌42株,以革兰阴性菌为主,共25株占59.5%;两组患者术后的血清γ-干扰素(IFN-γ)、白介素-2(IL-2)水平均较手术治疗前显著升高,血清IL-10水平较治疗前显著降低,手术前、后的差异均有统计学意义(P<0.05)。结论在直肠癌手术中,腹腔镜手术和开腹手术的感染部位和病原菌分布均具有一定的特征,两种术式均可改善患者的免疫因子表达水平,但腹腔镜手术可降低患者的术后感染率,临床医师应根据患者的病情进行选择应用。OBJECTIVE To analyze the effects of different surgical methods on the pathogenic bacteria distribution of nosocomial infections and the immune factor levels in patients with rectal cancer,so as to provide objective evidence for clinical treatment.METHODS A total of 120 patients with rectal cancer from Jan.2012 to Jan.2014 were selected as the research objects,and divided into laparotomy group（58cases）and laparoscopic surgery group（62cases）according to the surgical mode.The distribution of pathogenic bacteria,and the levels of serum immune factors before and after the operation of the patients in the two groups were observed and compared.RESULTS Totally 53 strains of pathogenic bacteria were isolated from the infected sites of the patients in laparotomy group,and 32 strains were gram-negative bacteria,accounting for 60.4%.Totally 42 strains of pathogenic bacteria were isolated from the infected sites of the patients in laparoscopic surgery group,and 25 strains were gram-negative bacteria,accounting for 59.5%.The serum levels of IFN-γand IL-2of the patients in the two groups were significantly higher than those before the surgery,the serum IL-10 level was significantly lower than that before the surgery（P〈0.05）.CONCLUSIONIn the surgery for rectal cancer,the distributions of infection sites and pathogenic bacteria of the laparoscopic surgery and the laparotomy surgery have certain characteristics,both of the surgeries can improve the levels of immune factors,but laparoscopic surgery can reduce the incidence of nosocomial infections.The clinicians should choose the application on the basis of the patient＇s condition.

关 键 词：直肠癌 术后感染 腹腔镜手术 免疫功能 

分 类 号：R657.1[医药卫生—外科学]