直肠癌手术切口感染的危险因素分析与预防对策

Risk factors for incision infections in patients undergoing rectal cancer surgery and prevention countermeasures

目的探讨直肠癌手术切口感染的危险因素,制定出有效的预防措施。方法回顾性分析医院2007年1月-2011年12月收治的456例直肠癌手术患者临床资料,对感染患者的相关感染因素进行单因素及多因素统计分析,以确定引起切口感染的危险因素。结果直肠癌手术患者共456例,术后发生切口感染43例,切口感染率为10.5%;合并有糖尿病、营养不良、手术切口长度>15.0cm、手术方式为APR、有术区污染、出血量>300ml、手术时间>3h、术前肠道准备不充分者及肿瘤分期较晚、伴有肠梗阻者与手术切口感染的发生具有相关性(P<0.05);合并糖尿病、白蛋白≤35g/L、Ⅲ期/Ⅳ期癌症、术式为APR、手术出血>300ml是影响SSI的独立危险因素。结论直肠癌手术切口感染,受多种因素影响,外科医师应从术前准备、手术操作因素、患者自身因素、抗菌药物应用等多方面考虑预防切口感染。

OBJECTIVE To explore the risk factors for incision infections in patients undergoing rectal cancer sur-gery and put forward effective prevention measures.METHODS The clinical data of 456 patients who underwent the rectal cancer surgery in the hospital from Jan 2007 to Dec 2011 were retrospectively analyzed,then the univari-ate and multivariate statistical analyses were performed for the related factors for the infections so as to define the risk factors for the incision infections.RESULTS The postoperative incision infections occurred in 43 of 456 pa-tients undergoing the rectal cancer surgery,with the incidence rate of 10.5%.The incidence of the surgical incision infections was associated with the complication of diabetic mellitus,malnutrition,length of surgical incision more than 15.0 cm,APR surgery,contaminated surgical area,blood loss volume more than 300ml,operation duration more than 3 hours,insufficient preoperative intestinal tract preparation,late tumor stage,and complication of in-testinal obstruction （P〈0.05）;the complication of diabetic mellitus,albumin level no more than 35 g/L,Ⅲ orⅣstage cancer,APR surgery,and blood loss volume more than 300 ml were the independent risk factors for the sur-gical incision infections.CONCLUSION There are a variety of influencing factors for the surgical incision infections in the patients undergoing the rectal cancer surgery.It is necessary for the surgeon to take consideration of preven-tion of the incision infections by starting from the preoperative preparation,surgical procedures,patient′s self fac-tors,and use of antibiotics.