术中冲洗液在结直肠癌术后切口感染预防中的应用

Application of washing fluid in preventing postoperative incisional infection of colorectal cancer

目的探讨术中冲洗液对结直肠癌术后切口感染预防中的应用。方法选取该院2012年1月-2015年12月行结直肠癌腹腔镜手术病例350例,随机分组,对患者术中分别使用无菌生理盐水、0.50%甲硝唑组、0.50%聚维酮碘液组,同时部分冲洗液在使用前进行加温至37~38℃,记录手术时间、手术部位,术后观察患者的切口感染情况,发生切口感染的患者,及时送分泌物做病原学检查;统计上采用单因素分析和Logistic多因素回归分析,分别对年龄、手术时间、手术部位、冲洗液种类、冲洗液温度行统计学分析。结果患者年龄≥60岁、手术时间≥2 h的切口感染率均高于年龄<60岁、手术时间<2 h的患者,差异有统计学意义(P<0.05);生理盐水组、0.50%甲硝唑、0.50%聚维酮碘液组,两两组间比较,0.50%甲硝唑和0.50%聚维酮碘液组的感染率分别为7.69%和8.55%,明显低于生理盐水组的16.38%;使用加温后的冲洗液的感染率低于常温冲洗液,分别为7.22%和14.71%,差异有统计学意义(P<0.05)。结论患者年龄≥60岁、手术时间≥2 h均是结直肠癌行腹腔镜手术后切口感染的危险因素,而选择0.50%甲硝唑、0.50%聚维酮碘液组和加温的冲洗液,是手术切口感染的保护性因素,可以应用到预防腹腔镜手术后切口感染中。

Objective To explore the application of washing fluid in the prevention of postoperative incisioninfection of colorectal cancer.Methods350patients with colorectal cancer underwent colorectal surgery from Jan.2012to Dec.2015were randomly divided into three groups:sterile saline,0.50%metronidazole,0.50%Povidoneiodinesolution group,while part of the rinse liquid heated to37~38℃before use,then record the operation time,surgical site,postoperative incision infection,incision infection,timely delivery statistical analysis was performedby using single factor analysis and logistic multivariate regression analysis.Age,operation time,surgical site,typeof irrigating fluid and temperature of flushing fluid were analyzed statistically.Results The incision infection rateof the patients≥60years old and the operation time≥2h was higher than the age<60years,and the operation timewas less than2h,P<0.05,the difference was statistically significant;0.50%metronidazole,0.50%Povidoneiodinesolution group,the infection rates of0.50%metronidazole and0.50%povidone-iodine group were7.69%and8.55%,respectively,which were significantly lower than those of the saline group16.38%The infection rate of therinsing fluid after heating was7.22%and14.71%,respectively,lower than that of the normal temperature rinsingsolution(P<0.05),the difference was statistically significant.Conclusions The risk factors of incisional infectionin colorectal cancer patients with colorectal cancer were:≥60years of age and≥2h of operation,while0.50%metronidazole,0.50%povidone-iodine solution and heated washing fluid were protective factors.It can be applied toprevent incision infection after laparoscopic surgery.