回肠造口还纳术后切口感染危险因素分析及皮下负压引流球的应用

Analysis of risk factors for postoperative incision infection in ileostomy closure technique and the application of subcutaneous negative pressure drainage ball

目的分析回肠造口还纳术后切口感染的危险因素,并探讨切口留置皮下负压引流球防治切口感染的效果。方法回顾性分析2013年2月~2017年5月在我院行回肠造口还纳术的283例患者资料,对有可能影响切口感染的临床病理因素进行单因素及多因素Logistic回归分析。比较切口留置皮下负压引流球组患者与无留置皮下负压引流球组患者在切口感染率、甲级愈合率、换药次数和住院时间的差异。结果术后共26例(9.2%)患者出现切口感染。单因素分析及多因素Logistic回归分析显示:BMI≥25kg/m^2、合并糖尿病、手术时间≥100min是回肠造口还纳术后切口感染的独立危险因素,而切口留置皮下负压引流球是术后切口感染的独立保护性因素(P均<0.05)。切口留置皮下引流球组患者较无留置皮下负压引流球组患者切口感染率低(3.9%vs13.5%)、切口甲级愈合率高(90.6%vs61.5%)、平均换药次数少[(3.6±0.7)次vs(7.0±1.5)次]、平均住院时间短[(7.7±2.1)dvs(12.3±3.6)d],差异均有统计学意义(P均<0.05)。结论BMI≥25kg/m2、合并糖尿病、手术时间≥100min是回肠造口还纳术后切口感染的独立危险因素。切口留置皮下负压引流球是防治回肠造口还纳术后切口感染的有效方法。

Objective To analyze the risk factors of incision infection after ileostomy closure technique and to investigate the effect of incision indwelling subcutaneous negative pressure drainage ball on prevention of wound infection.Methods A total of 283 patients who underwent ileostomy closure technique in our hospital from February 2013 to May 2017 were retrospectively analyzed.Univariate and multivariate logistic regression analysis was performed on clinicopathological factors that may affect wound infection.The differences in incision infection rate,grade A healing rate,dressing frequency and length of hospital stay were compared between patients with incision indwelling subcutaneous negative pressure drainage ball and those without incision indwelling subcutaneous negative pressure drainage ball.Results A total of 26 patients(9.2%)developed incision infection after sugery.Univariate analysis and multivariate logistic regression analysis showed that BMI≥25 kg/m2,the combination of diabetes mellitus,and operation time≥100 min were independent risk factors for incision infection after ileostomy closure technique.While incision indwelling subcutaneous negative pressure drainage ball was postoperative independent protective factors for wound infection(P all<0.05).Patients with incision indwelling subcutaneous negative pressure drainage ball had lower incision infection rate(3.9%vs 13.5%),higher grade A healing rate of incision(90.6%vs 61.5%),and fewer average dressing changes[(3.6±0.7)times vs(7.0±1.5)times]than those without incision indwelling subcutaneous negative pressure drainage ball,shorter average hospital stay[(7.7±2.1)d vs(12.3±3.6)d],and the difference was statistically significant(P all<0.05).Conclusion BMI≥25 kg/m^2,the combination of diabetes mellitus,and operation time≥100 min are independent risk factors for incisional infection after ileostomy closure technique.Incision indwelling subcutaneous negative pressure drainage ball is an effective means to prevent incision infection after ileostomy closure technique.