开腹和机器人胰十二指肠切除术手术部位感染病原菌分析  

Pathogens callsing surgical site infections between open and robotic pancreaticoduodenectomy

作　　者：魏红[1] 杜明梅[2] 张晓霞[1] 吴爱玉[1] 周宁[1] 李欣丰[1] 郭芳芳 刘运喜[2] WEI Hong;DU Ming-mei;ZHANG Xiao-xia;WU Ai-yu;ZHOU Ning;LI Xin-feng;GUO Fang-fang;LIU Yun-xi(Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046000,China)

机构地区：[1]长治医学院附属和平医院感染管理科,山西长治046000 [2]解放军总医院感染管理与疾病控制科,北京海淀100853

出　　处：《中华医院感染学杂志》2019年第20期3134-3138,共5页Chinese Journal of Nosocomiology

基　　金：解放军总医院医疗大数据研发基金资助项目(2017MBD-004)

摘　　要：目的探讨胰十二指肠切除术不同手术方法的手术部位感染情况,为医院感染防控提供依据。方法通过医院感染软件监测系统提取2018年9月-2019年6月于解放军总医院因胆管、胰腺或十二指肠肿瘤疾病接受胰十二指肠切除术患者389例的临床资料。按照不同手术方式分为开腹胰十二指肠切除术(Open pancreaticoduodenectomy,OPD)组201例和机器人胰十二指肠切除术(Robotic pancreaticoduodenectomy,RPD)组188例。比较两组患者基本特征、手术部位感染情况与特点。结果OPD组术前胆道引流患者38.31%(77/201)高于RPD组(P<0.001)。OPD组手术时间、术后住院时长和失血量分别为(4.90±1.21)h、14.00(11.00,19.00)d和200.00(150.00,300.00)ml长(多)于RPD组(P<0.001)。OPD组和RPD组手术部位感染率分别为8.46%、13.83%,差异无统计学意义(P=0.091),均以器官腔隙感染为主;感染病原菌以革兰阴性菌为主(61.54%),居前五位的病原菌是屎肠球菌、鲍氏不动杆菌、肺炎克雷伯菌、阴沟肠杆菌和弗氏柠檬酸杆菌。多药耐药菌占58.46%。结论相较于OPD,RPD是安全可行的。在围手术期用药方面应注意经验性抗菌药物的选择。OBJECTIVE To compare the surgical site infections of two different surgical methods between open and robotic pancreaticoduodenectomy,so as to provide a basis for nosocomial infection prevention and control.METHODS Clinical data of 389patients underwent pancreatiduodenectomy due to tumor diseases of bile duct,pancreas or duodenum from Sep.2018to Jun.2019were extracted by using the nosocomial infection monitoring system in PLA General Hospital.According to different surgical methods,201cases were regarded as the Open Pancreaticoduodenectomy(OPD)group and 188cases were in the Robotic Pancreaticoduodenectomy(RPD)group.The relevant data about basic features,the infection status and characteristics of surgical site were compared between two groups.RESULTS Preoperative biliary drainage of patients in OPD group were 38.31%(77/201),significantly higher than that in RPD group(P<0.001).Operation time,postoperative hospitalization and blood loss in the OPD group were(4.90±1.21)h,14.00(11.00,19.00)d and 200.00(150.00,300.00)mL respectively,which were significantly longer or more than those parameters in RPD group(P<0.001).The operative site infection rate of OPD group and RPD group was 8.46%and 13.83%,respectively,with no significant difference(P=0.091),all dominating by organ lacuna.Gram-negative bacteria were the main pathogenic bacteria(61.54%),and the top five pathogenic bacteria were Enterococcus faecalis,Acinetobacter baumannii,Klebsiella pneumoniae,Enterobacter cloacae and Citrate factorius.Multidrug resistant bacteria accounted for 58.46%.CONCLUSION Compared with OPD,RPD was safe and feasible,The selection of empiric antimicrobial agents should be paid attention to in perioperative medication.

关 键 词：开腹 机器人 胰十二指肠切除术 手术部位感染 

分 类 号：R619[医药卫生—外科学]