集束化干预对预防新辅助放化疗直肠癌术后手术部位感染疗效分析

Observational study of protective effects of cluster intervention on postoperative surgical site infection of rectal cancer

目的探讨新辅助放化疗直肠癌术后手术部位感染(SSI)的危险因素及集束化干预下预防感染的临床效果。方法分析2014年1月至2016年12月在江苏省中医院行新辅助放化疗直肠癌根治术105例患者病历资料。2015年3月开始采用术中集束化干预措施,按是否采用集束化干预分为集束化干预组(55例)和对照组(50例),分析两组SSI发生率,进一步根据是否发生SSI分为感染组及未感染组,比较两组临床因素之间的差异。结果集束化干预组SSI发生率9.1%(5/55),对照组为34.0%(17/50),两组差异有统计学意义(P=0.002)。相较未感染组,感染组中合并糖尿病、术中输血、肿瘤浸润超出肌层(T3+T4)、TNM分期较晚(Ⅲ+Ⅳ期)及未采用集束化干预比例显著升高(均P<0.05)。多因素logistic分析结果显示,未采用集束化干预、合并糖尿病、术中输血、TNM分期较晚(Ⅲ+Ⅳ期)是SSI发生的独立危险因素(均P<0.05)。结论集束化干预措施能降低新辅助放化疗直肠癌术后SSI发生率,未采用集束化干预、合并糖尿病、术中输血、TNM分期较晚(Ⅲ+Ⅳ期)是SSI发生的独立危险因素,采用集束化干预是降低新辅助放化疗直肠癌术后SSI发生的有效措施。

Objective To explore the risk factors of postoperative surgical site infection of rectal cancer and the clinical effects of cluster intervention on preventing infection.Methods Totally 105 patients who underwent radical resection of rectal cancer at Jiangsu Province Hospital of TCM from January 2014 to December 2016 were enrolled in this study.After March 2015,all patients received cluster intervention during surgery.These patients were then divided into cluster intervention group（55） and control group（50）,according to whether the cluster intervention measures were applied during the operations,then we analyzed the rate of SSI between the two groups.Furthermore,the clinical factors were compared between the infection group and noninfection group.Results The rate of SSI was 9.1%（5/55） in the cluster intervention group and 34%（17/50） in the control group;the difference between the two groups was statistically significant（P = 0.002）.Compared to the non-infection group,the proportions of concomitant diabetes,intraoperative blood transfusion,invasive depth beyond muscularis（T3＋T4）,later TNM stage（Ⅲ＋Ⅳ） and unused cluster intervention were significantly increased in the infection group（P〈0.05 for all）.The result of multivariate logistic analysis revealed that unused cluster intervention,concomitant diabetes,intraoperative blood transfusion and later TNM stage（Ⅲ螅？ Ⅳ？ were the independent risk factors for SSI（P = 0.002,0.007,0.007 and 0.01,respectively）.Conclusions The cluster intervention could decrease the rate of SSI for rectal cancer operation.Unused cluster intervention,concomitant diabetes,intraoperative blood transfusion and later TNM stage（Ⅲ＋Ⅳ） were the independent risk factors for SSI.The application of cluster intervention intraoperatively was the effective measure to decrease SSI rate for rectal cancer operation.