口腔颌面部恶性肿瘤术后手术部位感染因素分析

Risk factors of postoperative infection in patients with oral and maxillofacial malignant tumor

目的分析口腔颌面部恶性肿瘤患者术后手术部位感染的相关因素。方法采用回顾性研究方法,将240例口腔颌面部恶性肿瘤手术治疗患者纳入研究,统计术后手术部位感染发生率、肿瘤分布部位,根据是否发生感染分为感染组和非感染组;将术前血清白蛋白水平、术前牙结石情况、手术方式、术中是否使用抗生素、术中出血量、手术时长、置管时长、住院时长、术后放置引流管情况及转入重症加强护理病房(ICU)时长考虑为可能影响术后术区感染的因素,对比感染组与非感染组患者上述指标,进行单因素分析。将单因素分析发现可能相关的因素(P<0.05)纳入logistic回归分析,找出独立危险因素。结果舌癌患者术后手术部位感染率最高,其次为颊癌、唇癌、牙龈癌,而腭癌无感染发生,P <0.05。通过对比非感染组和感染组单因素分析发现感染组患者术前血清白蛋白≤35g/L、术前牙周结石Ⅲ度、术式Ⅲ(扩大切除+颈淋巴结清扫+皮瓣修复术)、术中使用抗生素、置管时间≤24h、住院时间>18d、术后放置引流管的百分率均较非感染组高,差异均有统计学意义(P<0.05)。两组在术中出血量、手术时长、转入ICU时长比较差异均无统计学意义(P>0.05)。多因素logistic回归分析发现导致患者术后手术部位感染的独立危险因素包括:术前牙周结石Ⅲ度(OR=7.149,P=0.014)、术前血清白蛋白≤35g/L(OR=0.059,P=0.034)、术式Ⅲ(OR=4.135,P=0.024)、住院时间>18d(OR=24.845,P=0.009)。结论研究发现术前牙周结石Ⅲ度、术前血清白蛋白值≤35g/L、术式Ⅲ、住院时间>18d是口腔颌面部恶性肿瘤患者术后手术部位感染的独立危险因素,且感染多发生在舌癌患者中,应针对具备上述特征的患者重点预防术后术区感染。

Objective To analyze the factors associated with postoperative surgical site infection(SSI) in patients with oral and maxillofacial malignancy. Methods A retrospective study was performed on 240 patients after surgical treatment of oral and maxillofacial malignancies. The incidence of postoperative SSI was calculated in terms of the location of tumor. Preoperative serum albumin level, preoperative periodontal calculus, surgical approach, intraoperative antibiotic use, intraoperative blood loss, length of surgery, duration of indwelling catheter, length of hospital stay, postoperative drainage tubes, and length of ICU stay were considered as potential risk factors for SSI in patients with oral and maxillofacial malignancy. These factors were compared between the patients with SSI and those without SSI by univariate analysis. The significant factors identified by univariate analysis(P<0.05) were included in multivariate logistic regression analysis to identify the independent risk factors. Results The highest incidence of SSI was found in patients with tongue cancer, followed by patients with carcinoma of buccal mucosa, carcinoma of lip, and carcinoma of gingiva. No infection was found in the patients with carcinoma of palate(P<0.05). Univariate analysis identifid that preoperative serum albumin level ≤ 35 g/L, preoperative periodontal calculus level 3, surgical approach III(extended resection + cervical lymph node dissection + flap repair), intraoperative use of antibiotics, duration ofindwelling catheter ≤ 24 h, length of hospital stay >18 days, postoperative drainage tube were significant factors of SSI(P<0.05). There were no statistically significant differences between the non-infected group and the infected group in intraoperative blood loss, duration of surgery and ICU stay(P>0.05). Multivariate logistic regression analysis found that preoperative periodontal calculus level 3(OR=7.149, P=0.014), preoperative serum albumin level ≤ 35 g/L(OR = 0.059, P=0.034), surgical approach III(OR=4.135, P=0.024), hospital stay >18 days(OR=24.845, P=0.009) were the independent risk factors for postoperative SSI in patients with oral and maxillofacial malignancy. Conclusions Preoperative periodontal calculus level 3, preoperative serum albumin level ≤ 35 g/L, surgical approach III, and hospital stay >18 days are independent risk factors for SSI in patients with oral and maxillofacial malignancy. Such SSI is relatively more prevalent in patients with tongue cancer. Corresponding measures should be taken for prevention of postoperative SSI in such patients.