不包括胆囊切除的开腹胆道手术后手术部位感染的危险因素分析

Risk factors for surgical site infection in patients after open biliary surgery excluding cholecystectomy

目的探讨不包括胆囊切除的开腹胆道手术后手术部位感染(SSI)的危险因素。方法回顾性分析2015年4月至5月在东方肝胆外科医院行不包括胆囊切除的开腹胆道手术的241例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男10~9例,女132例;年龄24~77岁,中位年龄58岁。收集患者一般资料,观察患者有否发生SSI。采用Logistic回归分析患者发生SSI的相关危险因素,并总结其预防措施。结果患者术后SSI发生率为8.3%(20/241)。发生时间均在术后1~14 d,中位时间为术后4 d。发生部位主要包括腹腔10例,胆道8例,切口2例。20例SSI患者中,15例为细菌感染,1例为真菌感染,4例未培养到细菌。Logistic回归多因素分析结果显示,胆肠吻合术、术前WBC>10×10~9/L和引流管留置时间>8 d是患者术后SSI的独立危险因素(OR=0.332,0.177,0.235;P<0.05)。结论不包括胆囊切除的开腹胆道手术后SSI的发生与胆肠吻合术、胆管炎症及术后引流密切相关。术前有效控制胆管炎症,术后确保引流通畅,对预防胆道术后SSI的发生具有重要意义。

Objective To explore the risk factors for surgical site infection （SSI） in patients after open biliary surgery excluding cholecystectomy. Methods Clinical data of 241 patients who underwent open biliary surgery excluding cholecystectomy in Eastern Hepatobiliary Surgery Hospital between April and May 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 109 males and 132 females, aged from 24 to 77 and with a median age of 58 years old. General data of the patients were collected and SSI was observed. Related risk factors for SSI of the patients were analyzed using logistic regression, and the preventive treatments were summarized. Results The incidence of postoperative SSI was 8.3% （20/241）. All SSI occurred on postoperative 1-14 d, with a median of 4 d. There were 10 cases whose SSI occurred at the abdomen, 8 cases at the biliary tract and 2 at the incision. Among the 20 cases with SSI, 15 cases suffered from bacterial infection, 1 case suffered from fungal infection and no bacteria was cultured in 4 cases. Multi-factor logistic regression analysis results showed that choledochojejunostomy, preoperative WBC 〉10× 109/L and drainage tube indwelling time 〉8 d were the independent risk factors for SSI of these patients （OR：0.332, 0.177, 0.235; P〈0.05）. Conclusions SSI of patients with open biliary surgery excluding cholecystectomy is closely related to choledochojejunostomy, bile duct inflammation and postoperative drainage. It is of great significance to effectively control bile duct inflammation and ensure postoperative unobstructed drainage in preventing SSI after biliary surgery.