术前口腔管理对肝癌患者肝切除术后手术部位感染的影响

Influence of preoperative oral administration on site infection after hepatectomy in patients with liver cancer

目的探讨术前口腔管理对肝癌患者肝切除术后手术部位感染(surgical site infections,SSI)的影响。方法回顾性分析2015年1月-2019年12月在上海交通大学医学院附属新华医院崇明分院肝胆外科进行肝癌肝切除术的334例患者的病例资料。排除糖尿病、急诊手术、血浆白蛋白<3.5 g/dL和同时进行结肠直肠切除或造口闭合等手术的患者。采集患者人口社会学因素、术前因素(口腔处理、实验室检查等)、围手术期因素。口腔管理干预包括自我管理指导、拔除感染牙齿、祛除斑和牙石(洗牙)、专业机械清洁牙齿、祛除舌苔、清洁假牙。SSI包括术后30 d内任何表浅切口感染、深部切口感染及器官腔隙感染。结果多因素Logistic回归分析发现腹水细菌感染(OR=13.72)、缺乏术前口腔管理(OR=10.17)和严重的肝纤维化(OR=2.76)是术后发生SSI的独立危险因素。结论术前口腔管理干预可降低行肝切除术的肝细胞癌患者发生SSI的风险。

Objective To investigate the effects of preoperative oral management on surgical site infections(SSI)in patients with hepatocellular carcinoma(HCC)following hepatectomy.Methods A total of 334 patients with hepatocellular carcinoma who underwent hepatectomy in hepatobiliary and pancreatic surgery in our hospital from January 2015 to December 2019 were enrolled.Demographic and social factors,preoperative factors(oral treatment,laboratory examination,etc.)and perioperative factors were collected.Oral management interventions include self-care instruction,removal of infected teeth,removal of plaque and calculus(tooth cleaning),professional mechanical cleaning of teeth,removal of tongue coating,and denture cleaning.SSI includes any superficial incision infection,deep incision infection,and lacunar infection within 30 days after surgery.Results Multivariate Logistic regression analysis showed that bacterial ascites infection(OR=13.72),lack of preoperative oral administration(OR=10.17)and severe liver fibrosis(OR=2.76)were independent risk factors for postoperative SSI.Conclusions Preoperative oral treatment may reduce the risk of SSI in hepatocellular carcinoma patients undergoing hepatectomy.