腹腔镜结直肠癌根治术后发生肺部感染的病原学及影响因素Logistic回归分析

The Etiology of Lung Infection after Laparoscopic Radical Resection of Colorectal Cancer and Logistic Regression Analysis on Influencing fFctors

目的:分析腹腔镜结直肠癌根治术后发生肺部感染的病原学及影响因素。方法:选取2017年1月~2020年12月某院普外科住院手术的526例结直肠癌患者进行研究。所有患者均选择腹腔镜根治术作为治疗方案,记录526例患者中发生术后肺部感染的例数及感染患者痰标本的致病菌类型,并根据术后肺部感染的发生情况将526例患者分为肺部感染组(63例)和非肺部感染组(463例),比较两组患者的一般资料,同时分析发生肺部感染的影响因素。结果:526例结直肠癌患者腹腔镜根治术后肺部感染63例,感染率为11.98%;63例术后肺部感染患者的痰标本中共检出病原菌54株,其中革兰阴性菌33株,革兰阳性菌17株,真菌4株;单因素分析结果显示,两组患者在年龄、吸烟史、慢性阻塞性肺疾病(COPD)、手术时间、术后切口明显疼痛、合并糖尿病方面比较差异均有统计学意义(P<0.05),在性别、术中出血量方面比较差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示,年龄≥60岁、吸烟史、COPD、手术时间≥3h、术后切口明显疼痛、合并糖尿病是结直肠癌患者腹腔镜根治术后发生肺部感染的独立危险因素(P<0.05)。结论:腹腔镜结直肠癌根治术后发生肺部感染的最常见致病菌为革兰阴性菌,结直肠癌患者术后发生肺部感染可能与年龄≥60岁、吸烟史、COPD、手术时间≥3h、术后切口明显疼痛、合并糖尿病密切相关。

Objective:To analyze the etiology and influencing factors of lung infection after laparoscopic radical resection of colorectal cancer.Methods:A total of 526 patients with colorectal cancer undergoing laparoscopic radical resection in a hospital from January 2017 to December 2020 were selected and studied.Laparoscopic radical surgery was chosen as the treatment regimen in all patients,and the number of patients with postoperative lung infection and types of pathogens in sputum specimens from infection patients were recorded in 526 patients.According to presence or absence of postoperative lung infection,they were divided into infection group(63 cases)and non-infection group(463 cases).The general data between the two groups were compared,and the influencing factors of lung infection were analyzed.Results:In the 526 patients with colorectal cancer after laparoscopic radical resection,there were 63 cases(11.98%)with lung infection.A total of 54 pathogens were detected in sputum samples from 63 patients with postoperative lung infection,including 33 strains of Gram-negative bacteria,17 strains of Gram-positive bacteria and 4 strains of fungi.The results of univariate analysis showed that the differences in age,smoking history,chronic obstructive pulmonary disease(COPD),operation time,significant postoperative incision pain and complicated with diabetes mellitus between the two groups were statistically significant(P<0.05),but the differences in gender and intraoperative blood loss were not statistically significant(P>0.05).The results of multivariate Logistic regression analysis showed that age≥60 years,smoking history,COPD,operation time≥3h,significant postoperative incision pain and complicated with diabetes mellitus were independent risk factors of lung infection in patients with colorectal cancer after laparoscopic radical resection(P<0.05).Conclusion:The most common pathogen of lung infection is Gram-negative bacteria in patients with colorectal cancer after laparoscopic radical resection.The occurrence of postoperative lung infection may be closely related to age≥60 years,smoking history,COPD,operation time≥3h,significant postoperative incision pain and complicated with diabetes mellitus.