229例术后腹腔感染的分析

Analysis of 229 cases of postoperative intra-abdominal infection

目的:探讨术后腹腔感染发生规律,提高对该类疾病的诊疗水平。方法:回顾性分析我院普通外科2013-01-2013-11术后并发腹腔感染和细菌培养阳性的229病例资料。结果:1229例患者检出共267株细菌;革兰氏阴性菌共180株(67.4%),革兰氏阳性菌共75株(28.1%),真菌共12株(4.5%);38例为两种细菌混合感染。2不同细菌感染原因:大肠埃希菌116株,以肝叶切除/胆囊切除/胆道探查术(31.0%)、结直肠肿瘤切除术(20.7%)最常见;肠球菌共48株中以胰腺手术(33.3%)、肝叶切除/胆囊切除/胆道探查术(31.3%)最常发生;肺炎克雷伯菌共25株中以肝叶切除/胆囊切除/胆道探查术(28.0%)、肠切除/肠道造口还纳术(21.4%)发生最多。结论:腹部术后腹腔感染以革兰氏阴性杆菌感染最常见,不同手术后感染细菌谱存在差异,临床应根据手术方式、细菌培养结果选择治疗方案。

Objective： To investigate the occurrence of postoperative intra--abdominal infection. Method：The clinical data of 229 cases with intra--abdominal infection and positive bacterial culture after abdominal operation from January 2013 to November 2013 were analyzed retrospectively. Result： （1）Totally 267 bacteria were isolated from 229 patients. Gram-negative bacteria were totally 180 stains （67.4 % ） ;Gram-positive bacteria were totally 75 stains （28.1 %） ;Fungi were totally 12 stains（4.5 % ）. Among them 38 stains were two kinds of bacteria mixed infection. （2）Different bacteria infection： 116 strains were Escherichia coil Hepatolobectomy/Cholecystectomy/Bile duct exploration（31.0） ,Colorectal cancer resection（20.7 % ） were the most common operation; 48 strains were En- terococcus. Pancreatic operation（33. 3 % ） and Hepatolobectomy/Cholecystectomy/Bile duct exploration （31. 3 %） were the most common operation;25 strains were Klebsiella pneumoniae,the most common operation were H epatolobectomy/Cholecystectomy/Bile duct exploration （28.0 % ） and Enterectomy/HaiNa after colostomy （ 21.4 % ）. Conclusion： Predominant bacteria of intra--abdominal infection after abdominal operation is Gram-negative bacilli. There are differences for infected bacteria spectrum after different operation. The treatment options should be based on operation methods, bacterial culture results in clinical work.