浸润性膀胱癌患者根治性膀胱切除术后感染切口愈合的危险因素分析

Risk Factors for Wound Healing of Infective Surgical Incision after Radical Cystectomy in Patients of Muscle Invasive Bladder Cancer

目的探索影响浸润性膀胱癌患者根治性膀胱切除术后感染切口愈合的危险因素。方法纳入2007年1月至2016年12月这10年间,于四川大学华西医院泌尿外科行开放或腹腔镜根治性膀胱全切除术后、病理证实为浸润性膀胱癌的患者,分为早期愈合组(术后14d内愈合)和延迟愈合组(术后所需愈合时间超过14d),比较两组切口感染基本情况、手术特点、围手术期指标、术后并发症、合并症及感染切口特点等临床资料,采用单因素logistic回归筛选潜在危险因素后建立多因素logistic回归模型,分析评价感染切口愈合的影响因素。结果共纳入171例患者,切口平均愈合时间为(17.9±16.9)d;早期愈合组118例,延迟愈合组53例。患者年龄、体质量指数(BMI)、手术切口类型、术前白蛋白水平、糖尿病、感染切口大小、感染切口伴窦道和潜行、术后发生肠瘘和尿瘘在两组间差异有统计学意义(P均<0.05)。单因素logistic回归分析结果示,男性、≥65岁、T4期肿瘤、切口类型-Ⅲ型(感染切口)、术前白蛋白低于30g/L、术前血红蛋白低于90g/L、糖尿病、感染切口大于30mm、感染切口伴潜行、术后发生肠瘘、术后发生尿瘘是感染切口延迟愈合的潜在危险因素。多因素logistic回归发现男性、T4期肿瘤、术前血红蛋白低于90g/L、≥65岁均不是感染切口延迟愈合的独立危险因素,主要独立危险因素为切口类型-Ⅲ型(标准偏回归系数=1.608)、感染切口大于30mm(标准偏回归系数=0.572)。建立的多因素logistic回归模型为Logit(P)=-5.900+4.118×尿瘘+3.693×切口类型+2.830×肠瘘+2.202×糖尿病+2.089×感染切口大小+1.574×术前白蛋白水平+1.287×感染切口伴潜行,当Logit(P)=1则预示术后手术切口愈合延迟的可能性高。结论根治性膀胱切除术切口类型为感染切口以及感染切口大于30mm是导致浸润性膀胱癌患者感染切口愈合延迟的主要独立危险因素。

Objective To evaluate the risk factors for wound healing of infective surgical incision in patients of muscle invasive bladder cancer undergoing radical cystectomy.Methods This study retrospectively collected clinical data of the patients who received radical cystectomy and experienced incisional infection after operation between January 2009 and December 2016.The patients were divided into early healing group and delayed healing group（the healing time is less or more than 14 dafter operation）.The risk factors for wound healing and infection were analyzed by single factor and multivariate logistic regression.Results A total of 171 patients with wound infection after radical cystectomy were included in the study.The average time of wound healing time was（17.9±16.9）d.There were 118 and 53 patients in early healing group and delay healing group respectively.Age,body mass index（BMI）,operative incision type,preoperative albumin level,diabetes mellitus,infection wound size,infection wound with sinus,postoperative intestinal fistula and urinary fistula were statistically significant differences between the two groups（P〈0.05）.Univariate logistic regression analysis indicated that male,older than 65 yr.,T4 stage,Type-Ⅲ surgical incision（infective incision）,low preoperative albumin level（〈30 g/L）,hemoglobin level（〈90 g/L）,diabetes,wound size（〉30 mm）,intestinal fistula,urinary fistula were risk factors for delayed woundhealing.Multivariate logistic regression analysis revealed that Type-Ⅲ surgical incision and wound size（〉30 mm）were independent risk factors for delayed wound healing.Conclusion Type-Ⅲ surgical incision and the size of wound（30 mm）are independent risk factors for delayed wound healing after radical cystectomy in bladder cancer patients.