比较食管癌微创手术与传统开胸术患者肺部感染的发生率

Comparison on incidence of pulmonary infection between minimally invasive surgery and traditional thoracotomy for the esophagus cancer

目的:探讨食管癌传统开胸术与微创术后肺部感染的发生率,为降低食管癌术后肺部感染的发生提供理论依据。方法:将我院2012年2月至2014年4月收治的272例拟行食管癌切除术病人随机分为传统开胸组(134例)和微创组(138例),进行随机对照研究;观察住院期间和出院后随访48 h内肺部感染的发生情况。结果:2组共有47例发生肺部感染,传统开胸组发生率为16.42%(22/134),微创组发生率为18.11%(25/138),其以鲍曼不动杆菌和铜绿假单胞菌为主要细菌;2组肺部感染的发生率无统计学差异(P>0.05);而2组中高龄(≥60岁)与低龄(<60岁)患者比较,高龄患者明显高于低龄患者(P<0.05);2组手术时间>5 h与≤5 h肺部感染的发生率相比较,差异具有统计学意义(P<0.05);2组中三切口患者发生率高于两切口患者(P<0.05);2组肺部感染的死亡率无明显差异(P>0.05)。结论:食管癌微创术与传统开胸术肺部感染发生与手术方式无关,主要需加强围手术期的管理,积极处理可能引起肺部感染的因素,以降低肺部感染的发生。

Objective：To explore the incidence of pulmonary infection between minimally invasive surgery and traditional thoracotomy for the esophagus cancer,and to provide theoretical basis for reducing the infection rate after esophagus surgery. Methods：Totally 272 patients admitted to our hospital from February of 2012 to April 2014,who were going to receive esophagus surgery,were randomly divided into two groups：traditional thoracotomy group（134 patients）and minimally invasive group（138 patients）. Pulmonary infection of the patients in hospital and at 48 h after discharge was observed. Results：Totally 47 patients were infected;the infection rates were16.42%（22/134）in traditional thoracotomy group,and 18.11%（25/138）in minimally invasive group,without significant differences between two groups（P〈0.05）. Most of bacteria were acinetobacter baumannii and pseudomonas aeruginosa. The infection rate within elder patients（≥60 years old）was much higher than that of younger patients（〈60 years old）（P〈0.05）.There were statistic differences in infection rate of between operation time longer than 5 h group and operation time shorter than 5 h group（P〈0.05）. For the patients in two groups,incidence of three operative incisions was higher than that of two operative incisions（P〈0.05）. The mortality of the pul monary infection was not difference between traditional thoracotomy group and minimally invasive surgery group（P〉0.05）. Conclusion：Pulmonary infection is not associated with the minimally invasive surgery and traditional thoracotomy in esophagus cancer. In order to reduce the pulmonary infection,we should improve the management during perioperative period and deal with the potential factors which can induce the infection.