一次性切口保护器预防肝内胆管结石肝切除患者术后切口感染的效果

Effects of disposable incision protector on prevention of incision infection after hepatectomy in patients with hepatolithiasis

目的探讨应用一次性切口保护器对肝内胆管结石开腹肝切除患者术后切口感染的预防作用。方法回顾性收集中山大学附属第一医院2015年1月—2018年12月使用一次性切口保护器行开腹肝切除术的肝内胆管结石患者作为干预组,同时收集2012年1月—2014年12月未使用切口保护器行肝部分切除术后的肝内结石患者作为对照组。使用倾向性匹配分析减少病例选择偏倚,比较匹配前后两组患者术后切口感染的发生率。结果原始队列中干预组共245例,对照组201例。干预组患者年龄小于对照组(P<0.05);干预组的既往有胆道手术史的比例低于对照组,手术时间短于对照组(均P<0.05)。匹配前干预组的术后切口感染发生率为5.7%(14/245),低于对照组的15.9%(32/201),差异有统计学意义(χ^(2)=4.436,P=0.035)。匹配后产生165对患者,每组各165例。两组的临床基线变量差异无统计学意义(P>0.05)。匹配队列中干预组的切口感染发生率为7.9%(13/165),低于对照组的15.2%(25/165),差异有统计学意义(χ^(2)=4.283,P=0.039)。结论一次性切口保护器可有效地预防肝内胆管结石行开腹肝切除患者发生术后切口感染。

Objective To explore the preventive effect of disposable incision protector on incision infection in patients with hepatolithiasis after open hepatectomy.Methods A retrospective collection of patients with hepatolithiasis who underwent open hepatectomy with a disposable incision protector from January 2015 to December 2018 in the First Affiliated Hospital of Sun Yat-sen University was used as the intervention group.At the same time,patients with hepatolithiasis who did not use the incision protector to undergo partial hepatectomy from January 2012 and December 2014 were collected as the control group.Propensity matching analysis was used to reduce case selection bias and incidences of postoperative incision infection between the two groups were compared before and after matching.Results In the primary cohort,there were 245 patients in the intervention group and 201 patients in the control group.Patients in the intervention group were younger than those of the control group(P<0.05).The proportion of patients with a history of biliary tract surgery in the intervention group was lower than that of the control group,and the operation time was shorter than that of the control group(all P<0.05).The incidence of incision infection in the intervention group before matching was 5.7%(14/245),lower than 15.9%in the control group(32/201),and the difference was statistically significant(χ^(2)=4.436,P=0.035).After propensity matching,165 pairs of patients were generated,there were 165 patients in each group.There was no statistically significant difference in clinical baseline variables between the two groups(P>0.05).In the matching cohort,the incidence of incision infection in the intervention group was 7.9%(13/165),which was lower than 15.2%(25/165)in the control group,and the difference was statistically significant(χ^(2)=4.283,P=0.039).Conclusions The disposable incision protector can effectively prevent postoperative incision infection in patients undergoing open hepatectomy for hepatolithiasis.