子宫切除术后切口感染的风险因素

Risk factors affecting incision infection after hysterectomy

目的明确子宫切除术后发生感染患者的临床及实验室特征。方法本研究为回顾性队列研究。从解放军第四○六医院档案室整理出2015年4月至2016年8月行子宫切除术的840例住院患者的病历资料,患者术式包括:经腹全子宫切除术(total abdominal hysterectomy,TAH)、腹腔镜子宫切除术(laparoscopic hysterectomy,LH)和阴式子宫切除术(vaginal hysterectomy,VH),记录年龄、体质量指数(body mass index,BMI)、术前及术后的实验室检查数据、妊娠等。结果 840例患者中,TAH占63. 2%(n=531)、LH为21. 6%(n=181)及VH为15. 2%(n=128)。子宫切除术后切口感染的发生率为3. 7%(n=31),其中,TAH切口感染的发生率是4. 5%,LH为1. 7%,VH为3. 1%,与患者术后切口感染相关的因素包括较高的BMI、术前及术后低红细胞压积、术后低血红蛋白,术后血小板计数较高的患者更容易发生术后切口感染。结论高BMI、术中失血量过多、低红细胞压积及贫血增加了子宫切除术后切口感染的发生率。在不同类型的子宫切除术中,LH与TAH和VH相比,术后切口感染的发生率相对较低。

Objective To identify clinical and laboratory features of the patients with surgical site infection( SSI) after hysterectomy. Methods This was a retrospective cohort study. The medical data of 840 patients undergoing hysterectomy from April2015 to August 2016 were collected from the No. 406 Hospital of CPLA for study. The surgical modes included: total abdominal hysterectomy( TAH),laparoscopic hysterectomy( LH) and vaginal hysterectomy( VH). Data concerning age,body mass index( BMI),laboratory data both before and after surgery,gravidity and state of pregnancy were all clearly documented. Results Of all the 840 patients,the patients with TAH,LH,and VH respectively accounted for 63. 2%( n = 531),21. 6%( n = 181),and 15. 2%( n = 128).After hysterectomy,the rate of SSI was 3. 7%( n = 31),of which the rate of TAH was 4. 5%,the rate of LH was 1. 7% and the rate of VH was 3. 1%. Data analysis revealed that the factors affecting SSI included higher BMIs,lower packed cell volume,lower hemoglobin level after surgery,and higher platelet counts after surgery. Such patients were more vulnerable to infection after surgery.Conclusion Higher BMI,more severe blood loss during surgery,low packed cell volume and resulting anemia all increased the incidence of SSI after hysterectomy. In different types of hysterectomy,the infection rate of LH was relatively lower,as compared with those of TAH and VH.