胰十二指肠切除术后并发深部真菌感染的相关因素分析

Factors Associated with Fungal Infection Following Pancreatoduodenectomy

目的探讨胰十二指肠切除术后并发深部真菌感染的相关因素,为预防术后深部真菌感染提供理论依据。方法对1995年1月至2005年1月期间我院562例行胰十二指肠切除术患者的相关资料进行单因素和非条件Logistic回归分析。结果①562例中有78例患者术后并发深部真菌感染,感染率为13.9%;共检出真菌88株,其中白色念珠菌59株(67.0%),光滑念珠菌10株(11.4%),近平滑念珠菌7株(8.0%),热带念珠菌5株(5.7%),曲霉菌4株(4.5%),其他3株(3.4%)。常见感染部位前3位是消化道66.7%(52/78),呼吸道21.8%(17/78),腹腔10.3%(8/78)。②本组病例中发生感染组与未感染组在术后发生的胰瘘、胆瘘、腹腔感染等并发症,长期使用抗生素,长时间肠外营养等方面差异具有统计学意义(P<0.05)。结论①胰十二指肠切除术后深部真菌感染最常见的部位和病原菌分别是肠道和白色念珠菌。②胰瘘、胆瘘、腹腔感染等并发症,长期使用抗生素,长时间肠外营养等方面是胰十二指肠切除术后并发深部真菌感染的最常见危险因素;减少各种危险因素有利于预防深部真菌感染。

Objective To investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation. Methods Medical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and non-condition Logistic regression analyse. Results ① Seventy-eight patients （13.9 % ） developed invasive fungal infection. The most frequently isolated fungal were Can- dida albicans accounted for 67.0%, and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ② Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula, biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.