胆总管结石患者腹腔镜与开放式手术后腹腔感染分析

Postoperative abdominal infections in choledocholithiasis patients undergoing laparoscopy and open surgery

目的探讨胆总管结石患者行腹腔镜与开放式手术后腹腔感染的对比及病原菌分布,从而合理应用手术方法,为临床医师提供帮助。方法选择2011年1月-2014年7月医院接治的149例胆总管结石需行手术治疗的患者为研究对象,根据手术方式的不同将其分为观察组72例行腹腔镜手术治疗,对照组77例行开放式手术治疗,分析两组患者的手术相关情况、腹腔感染率及腹腔感染病原菌分布,采用SPSS18.0软件对数据进行统计分析。结果患者腹腔感染率观察组为2.8%、对照组为13.0%,两组患者感染率比较,差异有统计学意义(P<0.05);感染患者病原菌分布主要为大肠埃希菌和粪肠球菌,分别占28.0%和24.0%;观察组患者手术时间、手术出血量、术后通气时间、胃肠功能恢复时间、住院时间均明显优于对照组,差异均有统计学意义(P<0.05)。结论患者采用腹腔镜手术治疗胆总管结石在手术时间、感染率等方面优于开放式手术,安全有效,临床应广泛使用。

OBJECTIVE To explore the postoperative abdominal infections in the choledocheolithiasis patients undergoing the laparoscopy and open surgery and observe the distribution of pathogens so as to choose appropriate surgery mode.METHODS A total of 149 choledocholithiasis patients who needed to received surgical procedures from Jan 2011 to Jul 2014 were recruited as the study objects and divided into the observation group with 72 cases and the control group with 77 cases.The observation group was treated with laparoscopy,and the control group was given the open surgery.The related status of the surgeries,incidence of abdominal infections,and distribution of pathogens causing abdominal infections were observed,and the statistical analysis of data was performed with the use of SPSS18.0software.RESULTS The incidence of abdominal infections was 2.8% in the observation group,13.0% in the control group,and there was significant difference in the infection rate between the two groups of patients（P〈0.05）.Of the pathogens causing the infections,28.0% were Escherichia coli,and 24.0%were Enterococcus faecalis.The operation duration,intraoperative bleeding volume,postoperative ventilation duration,time of recovery of gastrointestinal function,and length of hospital stay were significantly better in the observation group than in the control group（P〈0.05）.CONCLUSIONThe laparoscopy is superior to the open surgery in the treatment of the patients with choledocheolithiasis,including the operation duration and infection rate,and it is worthy to be promoted in the hospital.