结直肠癌患者外科手术部位感染的危险因素分析

Risk factors of surgical site infection in patients with colorectal cancer

目的：探讨结直肠癌术后手术部位感染（ SSI ）的发生率及相关危险因素。方法回顾性分析浙江省嘉兴市第一医院2011年10月至2014年12月行结直肠癌手术患者的病历资料，包括性别、年龄、基础疾病、吸烟史、预防用药情况、是否有腹部手术史、手术类型、术前血红蛋白和白蛋白水平、是否使用腹腔镜、是否使用吻合器、是否行联合脏器切除术、TNM分期、美国麻醉医生协会（ ASA）评分等。采用多因素Logistic回归分析法分析结直肠癌患者外科手术后SSI发生的危险因素。结果共有773例患者被纳入研究，其中144例发生SSI，SSI的发生率为18.63％。多因素Logistic回归分析发现，使用腹腔镜（ OR＝0.35，95％CI：0.15-0.79，P＜0．05）、使用吻合器（ OR＝0.59，95％CI：0.39-0.88，P＜0．05）是患者发生SSI的保护性因素；而糖尿病（ OR＝2.11，95％CI：1.25-3.58，P＜0．01）、肝硬化（OR＝2.12，95％CI：1.18-3.79，P＜0．05）、ASA评分（3-4分）（OR＝2.01，95％CI：1.20-3.58，P＜0．01）、联合脏器切除（OR＝2.17，95％CI：1.20-3.92，P＜0．05）、吻合口瘘（OR＝6.85，95％CI：3.01-15.63，P＜0．01）是患者发生SSI的危险因素。结论结直肠癌术后SSI的发生率较高，为减少SSI的发生，建议在手术中使用腹腔镜和吻合器。

Objective To investigate the incidence and risk factors of surgical site infection （ SSI ） in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists （ ASA） score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases （18.63%）.Multivariate logistic regression analysis showed that use of laparoscopy （ OR =0.35, 95%CI：0.15-0.79,P 〈0.05）, use of stapler （OR =0.59, 95% CI： 0.39-0.88,P 〈0.05） were protective factors for SSI, while diabetes （OR=2.11, 95% CI： 1.25-3.58,P〈0.01）, liver cirrhosis （OR=2.12,95%CI：1.18-3.79,P〈0.05）, ASA score （3-4 points） （OR=2.01,95%CI：1.20-3.58, P〈0.01）, combined organ resection （OR=2.17,95% CI：1.20-3.92,P〈0.05）, and anastomotic leak （OR=6.85, 95%CI：3.01-15.63,P〈0.01） were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .