结肠癌合并肠梗阻患者急诊术后切口感染的病原学与危险因素分析

Etiology and risk factors for incision infections in patients with colon cancer complicated with intestinal obstruction after emergency surgery

目的结肠癌合并肠梗阻急诊术后切口感染率较高,严重影响患者术后康复,本文旨在分析结肠癌合并肠梗阻患者急诊术后切口感染的病原学和危险因素,为临床防治结肠癌合并肠梗阻急诊术后感染提供参考。方法回顾性收集2011年1月-2016年6月医院收治的结肠癌合并肠梗阻的患者189例,所有患者均行急诊结肠癌切除术,观察切口感染率,分析患者的病原学和临床特征,并分析切口感染的危险因素。结果 35例患者发生切口感染,共培养出48株细菌,其中革兰阴性菌占62.50%,革兰阳性菌占37.50%;合并糖尿病的患者切口感染率显著增高(44.44%vs14.20%,P=0.000),手术时间≥150min的患者切口感染率显著增高(24.07%vs 11.11%,P=0.013),术前白细胞≥109/L的患者切口感染率显著增高(26.56%vs14.40%,P=0.042);C-反应蛋白≥10mg/L的患者切口感染率显著增加(22.88%vs11.27%,P=0.047);白蛋白<30g/L的患者切口感染率显著增加(29.09%vs14.18%,P=0.017);多因素logistic回归分析显示糖尿病、术前白细胞≥109/L、C-反应蛋白≥10mg/L和白蛋白<30g/L是结肠癌合并肠梗阻患者术后切口感染的危险因素。结论结肠癌合并肠梗阻患者急诊术后以革兰阴性菌常见,糖尿病、白细胞增高、C-反应蛋白增高和白蛋白降低是结肠癌合并肠梗阻患者急诊术后切口感染的危险因素。

OBJECTIVE The incidence rate of incision infections is high in the patients with colon cancer complicated with intestinal obstruction after emergency surgery, which may seriously affect the postoperative rehabilitation. To observe the etiology of the incision infections in the patients with colon cancer complicated with intestinal obstruction after emergency surgery and analyze the risk factors so as to provide guidance for clinical prevention and treatment of the incision infection after emergency surgery. METHODS A total of 189 patients with colon cancer complicated with intestinal obstruction who were treated in hospitals from Jan 2011 to Jun 2016 were retrospec- tively enrolled in the study, and all of the patients received the emergency colon cancer resection. The incidence rate of incision infection was observed, the etiological and clinical characteristics were analyzed, and the risk factors for the incision infection were analyzed. RESULTS Totally 48 strains of bacteria were isolated from 35 patients with incision infection, of which 62.50% were gram-negative bacteria, and 37.50% were gram-positive bacteria. The incidence rate of incision infection was significantly increasdd in the patients complicated with diabetic mellitus （44.44% vs 14.20% ,P=0.000） ; the incidence rate of incision infection was significantly increased in the patients with operation duration no less than 150 rain （24.07% vs 11.11% ,P=0. 013）; the incidence rate of incision infection was significantly increased in the patients with preoperative white blood cell counts no less than 109/L （26. 560% vs 14.40%,, P = 0. 042） ; the incidence rate of incision infection was significantly increased in the patients with the C-reactive protein （CRP） level no less than 10mg/L （22.88%vs11.27% ,P= 0. 047）% The incidence rate of incision infection was significantly increased in the patients with the albumin level less than 30g/L （29.09%vsl4. 18 % ,P= 0. 017）. The multivariate logistic regression analysis indicated that the risk factors for the postoperative incision infection in the patients with colon cancer complicated with intestinal obstruction included the diabetic mellitus, preoperative white blood cell counts no less than 10g/L, CRP level no less than 10mg/L, and albumin level less than 30g/L. CONCLUSION The gram-negative bacteria are the most common in the patients with colon cancer complicated with intestinal obstruction after emergency surgery. The risk factors for the postoperative incision in- fections in the patients with colon cancer complicated with intestinal obstruction include diabetic mellitus, increase of white blood cells counts, elevation of CRP level, and reduction of albumin level.