影响克罗恩病肠切除术后切口感染的危险因素分析  

Risk factor analysis of incisional infection in Crohn＇s disease patients after bowel resection

作　　者：刘华山 张珑娟[2] 粱振兴 胡拓 周驰[1] 何小文[1] 吴小剑[1] 吴现瑞[1] Liu Huashan;Zhang Longjuan;Liang Zhenxing;Hu Tuo;Zhou Chi;He Xiaoweu;Wu Xiaojian;Wu Xianrui(Department of Colorectal and Anal Surgery,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院结直肠肛门外科,广州510655 [2]中山大学附属第一医院普通外科,广州510080

出　　处：《中华消化外科杂志》2018年第9期935-942,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81870383）;广东省科技计划项目（20158020229001）;广东省自然科学基金（2017A030313785）;广州市科技计划项目（201804010014）

摘　　要：目的分析影响克罗恩病肠切除术后切口感染的危险因素。方法采用回顾性病例对照研究方法。收集2007年1月至2016年12月中山大学附属第六医院收治的239例克罗恩病行肠切除术患者的临床病理资料。患者均行肠切除术。观察指标：（1）手术情况。（2）随访情况。（3）影响术后切口感染的危险因素分析。（4）影响患者术前贫血的临床因素。采用门诊或病房接诊方式进行随访，随访内容为术后30d内切口感染情况。随访时间截至2017年1月。采用Shapiro-Wilk进行正态性检验。正态分布的计量资料以x±s表示，组间比较采用t检验；偏态分布的计量资料以M（范围）表示，组间比较采用Wilcoxon秩和检验。单因素和多因素分析采用Logistic回归模型，将单因素分析中P〈O．05的指标纳入多因素分析中以逐步向前法进行分析。结果（1）手术情况：239例患者中，11例行急诊手术、228例行择期手术；65例行腹腔镜手术、174例行开腹手术；手术方式均为肠切除术，肠切除术后179例行消化道重建吻合，81例行肠造口术（21例联合行肠吻合和造口术）。239例患者术中发现纤维性狭窄137例、肠瘘113例、小肠梗阻101例、脓肿58例、蜂窝组织炎54例、肠穿孔11例（部分患者合并多种症状）。（2）随访情况：239例患者术后30d均获得随访，随访期间48例发生切口感染，均经对症支持治疗后好转。（3）影响术后切口感染的危险因素分析：①单因素分析结果显示：疾病行为、红细胞沉降率〉20mm／h、术前贫血、术前合并慢性肠瘘、开腹手术、术中发现纤维性狭窄、术中发现肠瘘是影响克罗恩病患者术后切口感染发生的危险因素（比值比=2．530，2．579，4．233，2．988，2．554，0．503，3．052，95％可信区间：1．218～2．259，1．141～5．833，1．598～11．210，1．522—5．864，1．082～6．029，0．265Objective To analyze the risk factors affecting postoperative incisional infection in Crohn＇s disease （CD） patients after bowel resection. Methods The retrospective case-control study was conducted. The clinicopathological data of 239 CD patients who underwent bowel resection in the Sixth Affiliated Hospital of Sun Yat-sen University between January 2007 and December 2016 were collected. All patients underwent bowel resection. Observation indicators ： （ 1 ） surgical situations ; （2） follow-up ; （ 3 ） risk factors analysis affecting postoperative incisional infection; （4） clinical factors affecting preoperative anemia. The follow-up using outpatient examination or ward diagnosis was performed to detect incisional infection within 30 days postoperatively up to January 2017. The normality test was done by Shapiro-Wilk. Measurement data with noi^lal distribution were represented as x±s, and comparison between groups was evaluated with the t test. Measurement data with skewed distribution were described as M （range） , and comparison between groups was analyzed using the Wilcoxon rank- sum test. The univariate analysis and multivariate analysis were done using the Logistic regression model. The P〈 0. 05 in univariate analysis was incorporated into multivariate analysis for analysis in the forward wald. Results （ 1 ） Surgical situations ： of 239 patients, 11 underwent emergency surgery and 228 underwent elective surgery; 65 amt 174 underwent respectively laparoscopic surgery and open surgery; 179 received digestive tract reconstruction and anastomosis and 81 received enterostomy （21 combined with anastomosis and enterostomy）. Among 239 patients, 137, 113, 101, 58, 54 and 11 were complicated respectively with fiber stenosis, intestinal fistula, obstruction of small intestine, abscess, cellulitis and enterobrosis （some patients combined with multiple signs）. （2） Follow-up： 239 patients were followed up at 30 days postoperatively. During the follow-up, 48 with incisional

关 键 词：克罗恩病 肠切除术 切口感染 贫血 危险因素 

分 类 号：R656.9[医药卫生—外科学]