解剖性肝切除术后腹腔感染并发症分析  

Retrospective study on the risk factors related to intraabdominal infection after anatomical hepatectomy

作　　者：田亚丽 陈莲 孙青[1] 崔昕龙[1] 刘世腾 毛谅[2] 仇毓东[2] 李冰冰[1] Tian Yali;Chen Lian;Sun Qing;Cui Xirdong;Liu Shiteng;Mao Liang;Qiu Yudong;Li Bingbing(Department of Anesthesiology,Drum Tower Hospital,Nanjing University,Nanjing 210008,China;Department of General Surgery,Division of Hepatobiliary Pancreatic Surgery,Drum Tower Hospital Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008 [2]南京大学医学院附属鼓楼医院普通外科肝胆胰中心,210008

出　　处：《中华普通外科杂志》2019年第9期762-765,共4页Chinese Journal of General Surgery

基　　金：南京市青年卫生人才项目(QRX17013);南京市卫健委课题(YKK17084)。

摘　　要：目的分析解剖性肝切除患者术后腹腔感染并发症发生率及相关的危险因素。方法回顾性分析我院实施解剖性肝脏切除手术的122例患者的临床资料,记录术中晶体和胶体的使用量、出血量、输血量、血管活性药物、术后肝功能、炎症指标、腹腔感染以及住院时间。结果根据术后是否发生腹腔感染分为感染组(n=39)和未感染组(n=83)。单因素分析示腹腔感染和肝硬化、直接胆红素、丙氨酸转氨酶、手术时间、胆管切开引流或胆肠吻合、术中胶体量、晶体量、输液总量、红细胞悬液输注量,术后第1天直接胆红素量相关(P<O.05);多因素分析示腹腔感染与术中胶体使用量以及行胆管空肠吻合等手术操作相关(P<0.05)。结论术中胶体使用量以及行胆管空肠手术操作是术后腹腔感染发生的危险因素。Objective To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.Methods The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed.The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused,intraoperative estimated blood loss,volume of blood transfusion,the dosage of vasoactive drugs,postoperative liver function,inflammation index,the incidence of intraabdominal infection and the length of hospital stay(LOS).Results Patients were divided into infection group(n=39)and noninfection group(n=83).Intraabdominal infection was correlated with preoperative cirrhosis,the elevated direct bilirubin and alanine aminotransferase,the duration of operation,bilioenteric anastomosis or cholangiotomy,the infusion volume of colloid and crystalloid fluid,transfusion volume,direct bilirubin level on the POD 1(post-operation on day 1)(P<0.05);Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P<0.05).Conclusions Intraoperative infused volume of synthetic colloid,along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.

关 键 词：肝切除术 液体管理 腹腔感染 

分 类 号：R65[医药卫生—外科学]