腹腔镜下结直肠癌术后感染并发症的特点及危险因素分析

Analysis of characteristics and risk factors of postoperative infectious complications of laparoscopic colorectal cancer surgery

目的探讨腹腔镜下结直肠癌术后感染并发症的特点及危险因素,以针对性采取措施降低感染率。方法回顾性分析2011年2月—2016年2月在新昌县人民医院行腹腔镜下结直肠癌手术患者204例,对术后感染并发症特点进行归纳,并从年龄、糖尿病、肺部疾患、手术时间、中转手术、TNM分期、体质量指数、术中出血量等方面对感染进行危险因素分析。结果腹腔镜下结直肠癌术后感染24例,发生率为11.76%,感染分布中腹腔脓肿发生率最高,比率为41.67%,切口感染、院内获得性肺炎、下尿路感染、导管相关感染发生率分别为29.17%、12.50%、8.33%、8.33%,腹腔脓肿和其他感染比较差异有统计学意义(P<0.05);危险因素有存在肺部疾患、手术时间长(>180 min)、存在糖尿病(P<0.05),而与性别、年龄、中转手术、体质量指数、术中出血量、TNM分期无关(P>0.05);其中手术时间、糖尿病、肺部疾患是腹腔镜结直肠癌术后感染独立危险因素(Wald值分别为9.679、10.121、13.893,P值分别为0.011、0.014、0.025)。结论腹腔镜下结直肠癌术后感染以腹腔脓肿最常见,其中手术时间、糖尿病、肺部疾患是腹腔镜结直肠癌术后感染独立危险因素,在临床上要加强观察。

Objective To evaluate the characteristics and risk factors of postoperative infectious complications of laparoscopic colorectal cancer surgery in order to take targeted measures to reduce infection rates. Methods A retrospective analysis of 205 patients undertaking laparoscopic colorectal surgery from February,2011 to February,2016 was made to summarize the postoperative infectious complications characteristics as well as the risk factors such as the age, diabetes, lung disease, surgery time, surgical intervention, TNM stage, body mass index, blood loss,infection. Results There are 24 cases of postoperative infection following laparoscopic coloreetal cancer surgery, and the infectious rate was 11.76%, a- mong which abdominal abscess ranks the highest with a infectious rate 41.76% followed by wound infeetion,nosocomial pneumonia,urinary tract infections ,catheter-related infections with infectious rates of 29.17% , 12.50% ,8.33% ,8.33% respectively. Compared with other kinds of infections, abdominal abscess has statistical difference （ P 〈 0.05 ）. The risk factors include lung disease,long operative time （ 〉 180 min）, and diabetes （ P 〈 0.05 ） , irrelevant to age, surgical intervention, body mass index, blood loss, TNM stage-independent （ P 〉 0.05 ）. The operation time, diabetes, lung disease infection after laparoscopic colorectal cancer surgery are independent risk factors （ Wald values were 9. 679,10.121,13. 893 ; P values were 0.011,0. 014,0. 025 ）. Conclusion Abdominal abscess is the most common infection following laparoscopic colorectal cancer surgery,while the operation time, diabetes,lung disease infection are independent risk factors which need further observation in clinical practice.