腹腔镜手术术后脐部通道切口感染发生率及其危险因素分析

Incidence and risk factors of umbilical channel incision infection after laparoscopic surgery

目的:分析腹腔镜手术术后脐部通道切口感染发生率及其危险因素。方法:选择816例行腹腔镜手术患者作为研究对象,随访2个月,观察其术后脐部通道切口感染发生情况,根据是否发生感染分为感染组和非感染组,比较两组的临床病理因素,进行单因素分析和多因素Logistic回归分析;使用受试者工作特征曲线(ROC)下面积(AUC)量化相关因素对脐部通道切口感染的预测效能。结果:在本研究816例行腹腔镜手术患者中,术后脐部通道切口发生感染78例,发生率为9.56%;感染组与非感染组在性别、年龄、体重指数(BMI)、糖尿病、低白蛋白血症、手术类别、术中神经牵拉或损伤、手术时间、术后切口引流、围手术期低体温方面比较差异均有统计学意义(均P<0.05);多因素Logistic回归分析表明,手术类别、围手术期低体温、手术时间、切口引流均是引起脐部通道切口感染的独立危险因素(均P<0.05);感染组围手术期体温低于非感染组,切口引流时间和手术时间均长于非感染组,差异均有统计学意义(均P<0.001);经ROC曲线分析,围手术期体温、切口引流时间联合手术时间预测脐部通道切口感染的AUC为0.915,明显大于单一因素的AUC,差异有统计学意义(P<0.05)。结论:腹腔镜手术术后脐部通道切口感染与手术类别、围手术期低体温、手术时间、切口引流有关,临床应严格掌握其独立影响因素,加强围术期管理,以期减少脐部通道切口感染发生。

Objective:To analyze the incidence of umbilical channel incision infection and its risk factors after laparoscopic surgery.Methods:816 patients undergoing laparoscopic surgery were selected as the research objects.They were followed up for 2 months to observe the incidence of umbilical channel incision infection.They were divided into infection group and non-infection group according to whether there was infection.The clinicopathological factors of the two groups were compared and analyzed by univariate analysis and multivariate Logistic regression analysis.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to quantify the predictive efficacy of related factors for umbilical channel incision infection.Results:Among 816 patients,78 cases of infection occurred in the umbilical channel incision after surgery,with an incidence rate of 9.56%.There were significant differences in gender,age,BMI,diabetes,hypoalbuminemia,surgery type,intraoperative nerve stretch or injury,operation time,postoperative incision drainage,perioperative hypothermia in the infection group and non-infection group(all P<0.05).Multivariate Logistic regression analysis showed that the type of surgery,perioperative hypothermia,operation time and incision drainage were independent risk factors for umbilical channel incision infection(all P<0.05).The perioperative temperature of the infection group was lower than that of the non-infection group,and the incision drainage time and operation time were longer than those of the non-infection group(all P<0.001).The ROC curve analysis showed that the perioperative temperature,incision drainage time combined with the operation time predicted the AUC of the umbilical channel incision infection was 0.915,which was significantly larger than the AUC of a single factor(P<0.05).Conclusion:After laparoscopic surgery,the infection of the umbilical channel incision is related to the type of operation,perioperative hypothermia,operation time,and incision drainage.The clinic should strictly grasp its independent influencing factors and strengthen the perioperative management in order to reduce the incidence of umbilical channel incision infection.Infection of the umbilical channel incision after laparoscopic surgery is related to the type of surgery,perioperative hypothermia,operation time,and incision drainage,the independent influencing factors should be strictly controlled in the clinic,and perioperative management should be strengthened in order to reduce of infection of umbilical channel incision.