L型细菌感染与慢性结石性胆囊炎手术部位感染相关性的巢式病例对照研究  

A nested case-control study on the relationship between L-form bacterial infection and surgical site infection in chronic calculous cholecystitis

作　　者：谢朝云 杨波 杨忠玲 Xie Chaoyun;Yang Bo;Yang Zhongling(Department of Infection Management,the Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,Guizhou Province,China;Department of General Surgery,the Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,Guizhou Province,China;Department of Laboratory,the Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,Guizhou Province,China)

机构地区：[1]贵州医科大学第三附属医院感染管理科,贵州都匀558000 [2]贵州医科大学第三附属医院普外科,贵州都匀558000 [3]贵州医科大学第三附属医院检验科,贵州都匀558000

出　　处：《中华肝胆外科杂志》2021年第10期757-761,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：贵州省科技厅联合项目(黔科合LH字(2014)7162号);贵州省黔南州社会发展科技项目(黔南科合社字(2018)7号)。

摘　　要：目的分析L型细菌感染与慢性结石性胆囊炎患者腹腔镜胆囊切除术(LC)术后手术部位感染(SSI)的关联性,为临床预防SSI提供干预措施。方法采用前瞻性巢式病例对照研究方法,收集2016年9月至2020年6月在贵州医科大学第三附属医院行LC的慢性结石性胆囊炎患者作为研究对象。术后随访观察时间为手术之日起1个月内,详细记录患者一般资料、围手术期情况、胆囊内容物L型细菌检出情况、术后SSI等指标,以及术者术前完成LC例数。根据术后是否发生SSI按照1∶4比例进行配对分组:SSI组和对照组。多因素logistic回归分析LC术后发生SSI的危险因素。结果共有695例患者被纳入研究,其中男性248例,女性447例,年龄(46.0±15.0)岁。SSI组(n=139)与对照组(n=556)L型细菌感染率分别为45.32%与30.94%,SSI组L型细菌感染率显著高于对照组(P<0.05)。L型细菌感染(OR=2.082,95%CI:1.335~3.197,P=0.001)、胆囊破裂(OR=2.249,95%CI:1.352~3.740,P=0.002)、胆囊及周围组织粘连(OR=1.903,95%CI:1.133~3.194,P=0.015)、术中出血量多(OR=2.247,95%CI:1.418~3.561,P=0.001)可增加慢性结石性胆囊炎患者LC术后发生SSI的风险,而术者术前完成LC例数多(OR=0.549,95%CI:0.340~0.888,P=0.014)可降低SSI风险。结论L型细菌感染是SSI的危险因素之一,加强慢性结石性胆囊炎患者L型细菌感染筛查,提高手术操作技能,重点注意胆囊及周围粘连患者的手术操作,减少术中出血量,避免胆囊破裂,可减少LC术后发生SSI的风险。Objective To study the correlation between L-form bacterial infection and surgical site infection(SSI)after laparoscopic cholecystectomy(LC)in patients with chronic calculous cholecystitis,and to find out the interventional measures which can be used in clinical prevention of SSI.Methods Using a prospective nested case-control study,patients with chronic calculous cholecystitis who underwent LC at the Third Affiliated Hospital of Guizhou Medical University from September 2016 to June 2020 were prospectively studied.The postoperative follow-up observation time was within 1 month from the date of surgery.The patients’general information,perioperative conditions,presence of L-form bacteria in gallbladder contents,postoperative SSI and other indicators,as well as the data entered by the surgeons before the operations were collected in detail.According to whether SSI occurred or not after operation,these patients were paired and grouped in a ratio of 1∶4 between the SSI group versus the control group.Multivariate logistic regression analysis was used to determine the risk factors for SSI after LC.Results Of 695 patients included in the study,there were 248 males and 447 females,aged(46.0±15.0)years old.The infection rates of L-form bacteria in the case group and the control group were 45.32%and 30.94%,respectively.The infection rate of L-form bacteria in the case group was significantly higher than that in the control group(P<0.05).The L-form bacterial infection rate(OR=2.082,95%CI:1.335-3.197,P=0.001)suggested that L-form bacterial infection significantly increased the risk of SSI.In addition,rupture of gallbladder during surgery,(OR=2.249,95%CI:1.352-3.740,P=0.002),adhesion of gallbladder to surrounding tissues(OR=1.903,95%CI:1.133-3.194,P=0.015),and excessive bleeding during operation(OR=2.247,95%CI:1.418-3.561,P=0.001)also increased the risk of SSI,while increased experience of operating surgeons on number of surgical cases(OR=0.549,95%CI:0.340-0.888,P=0.014)decreased the risk of SSI.Conclusion L-form bacteri

关 键 词：胆囊炎 胆囊切除术 腹腔镜 外科伤口感染 L型细菌 病例对照研究 

分 类 号：R657.41[医药卫生—外科学]