基于单中心数据库的结肠癌术后手术部位感染危险因素分析  

Risk factors of postoperative surgical site infection in colon cancer based on a single center database

作　　者：国瑀辰 孙蕊 吴斌 林国乐 邱辉忠 李珂璇 侯文运 孙曦羽 牛备战 周皎琳 陆君阳 丛林 徐徕 肖毅 Guo Yuchen;Sun Rui;Wu Bin;Lin Guole;Qiu Huizhong;Li Kexuan;Hou Wenyun;Sun Xiyu;Niu Beizhan;Zhou Jiaolin;Lu Junyang;Cong Lin;Xu Lai;Xiao Yi(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100006,China;Department of Gastrointestinal Surgery,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100006 [2]吉林大学第一医院胃结直肠外科,长春130021

出　　处：《中华胃肠外科杂志》2022年第3期242-249,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费临床与转化医学研究基金(2019XK320003)。

摘　　要：目的探讨结肠癌术后手术部位感染(SSI)发生率及其危险因素。方法采用回顾性病例对照研究方法。检索北京协和医院基本外科结直肠专业组前瞻性登记的临床数据库,收集2016年1月至2021年5月期间,接受结肠癌手术的患者病例资料,包括患者基线资料、围手术期资料、术后并发症和随访资料。排除标准:(1)同时性多原发结肠癌;(2)接受分段切除、或结肠次全切除、或结肠全切除;(3)手术行一期肠造口术,或术前处于肠造口状态的患者;(4)经自然腔道标本取出手术或经阴道结肠手术;(5)患者有结肠切除手术史;(6)因肠梗阻、穿孔、急性出血等原因接受急诊手术;(7)行肠短路手术;(8)术后病理提示为良性病变;(9)未按照我科结直肠临床路径进行肠道准备和抗生素应用的患者。通过单因素分析和多因素分析探索结肠癌患者术后SSI的独立相关因素。结果共1291例患者被纳入研究,腹腔镜手术率为94.3%(1217/1291),总体手术部位感染的发生率为5.3%(69/1291)。按照肿瘤部位划分,肿瘤位于右半结肠、横结肠、左半结肠和乙状结肠的SSI发生率分别为8.6%(40/465)、5.2%(11/213)、7.1%(7/98)和2.1%(11/515)。按照不同切除范围划分,右半结肠切除、横结肠切除、左半结肠切除和乙状结肠切除术后SSI发生率分别为8.2%(48/588)、4.5%(2/44)、4.8%(8/167)和2.2%(11/492)。单因素分析发现,术前血尿素氮≥7.14 mmol/L、肿瘤部位、手术切除范围、肠吻合途径、术后腹泻、术后吻合口漏及术后肺炎与SSI发生有关。多因素分析提示,吻合口漏(OR=22.074,95%CI:6.172~78.953,P<0.001)、术后肺炎(OR=4.100,95%CI:1.546~10.869,P=0.005)和全腔镜吻合(OR=5.288,95%CI:2.919~9.577,P<0.001)是术后SSI的独立危险因素。在亚组分析中发现,右半结肠切除的患者中,在全腔镜吻合下SSI发生率为19.8%(32/162),高于非全腔镜吻合的患者(3.8%,16/426),差异有统计学意义(χ2=40.064,P<0.001Objective To explore the incidence and risk factors of postoperative surgical site infection(SSI)after colon cancer surgery.Methods A retrospective case-control study was performed.Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included,and demographic characteristics,comorbidities,laboratory tests,surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery,Peking Union Medical College Hospital.Case exclusion criteria:(1)simultaneously multiple primary colon cancer;(2)segmental resection,subtotal colectomy,or total colectomy;(3)patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation;(4)patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery;(5)patients with the history of colectomy;(6)emergency operation due to intestinal obstruction,perforation and acute bleeding;(7)intestinal diversion operation;(8)benign lesions confirmed by postoperative pathology;(9)patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application.Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery.Results A total of 1291 patients were enrolled in the study.94.3%(1217/1291)of cases received laparoscopic surgery.The incidence of overall SSI was 5.3%(69/1291).According to tumor location,the incidence of SSI in the right colon,transverse colon,left colon and sigmoid colon was 8.6%(40/465),5.2%(11/213),7.1%(7/98)and 2.1%(11/515)respectively.According to resection range,the incidence of SSI after right hemicolectomy,transverse colectomy,left hemicolectomy and sigmoid colectomy was 8.2%(48/588),4.5%(2/44),4.8%(8/167)and 2.2%(11/492)respectively.Univariate analysis showed that preoperative BUN≥7.14 mmol/L,tumor site,resection range,intestinal anastomotic approach,postoperative diarrhea,a

关 键 词：结肠癌 手术部位感染 结肠手术 回顾性研究 相关因素 

分 类 号：R735.35[医药卫生—肿瘤]