胰十二指肠切除术后感染的危险因素分析

Risk Factors for Infection after Pancreaticoduodenectomy

目的:分析胰十二指肠切除术(PD)后原发手术部位感染(SSI)的主要危险因素。方法:回顾性分析2017年8月-2020年8月江苏省建湖县人民医院行PD患者141例临床资料,根据术后30 d是否发生SSI分为SSI组(56例)、非SSI组(85例)。所有患者术后进行SSI发生的单因素分析、多因素回归分析及SSI定量评分系统和预测效能。结果:SSI组患者年龄大于非SSI组,基础疾病、恶性肿瘤、腹腔镜中转开腹、术后输血比例大于非SSI组,术中出血量多于非SSI组,术后白蛋白浓度低于非SSI组,腹腔并发症发生率高于非SSI组,差异有统计学意义(P<0.05)。年龄(>65岁)、基础疾病、恶性肿瘤、术后输血、术后低白蛋白(≤40 g/L)和腹腔并发症是SSI发生的独立危险因素(P<0.05)。受试者工作曲线显示,评分系统预测SSI发生的曲线下面积为0.825(P<0.05)。结论:年龄、基础疾病、恶性肿瘤、术后输血、术后低白蛋白、腹腔并发症等均属于SSI发生的独立危险因素,临床医生在今后实际工作中应准确评估PD患者具体生理状态,针对存在SSI高危因素者适时、适当采取针对性干预措施从而降低其SSI发生风险。

Objective:To analyze the main risk factors for primary surgical site infection(SSI)after pancreaticoduodenectomy(PD).Methods:Retrospectively analyzed the clinical data of one hundred and forty-one patients who underwent PD in Jianhu County People's Hospital from August 2017 to August 2020.According to whether SSI occurred 30 d after surgery,they were divided into SSI group(56 cases)and non-SSI group(85 cases).Univariate analysis,multi-factor regression analysis and quantitative scoring system of SSI and predictive efficacy of SSI occurrence were performed in all patients postoperatively.Results:The age of patients in the SSI group was greater than that in the non-SSI group,the proportion of underlying disease,malignancy,laparoscopic intermediate open abdomen,and postoperative blood transfusion was greater than that in the non-SSI group,intraoperative bleeding was more than that in the non-SSI group,postoperative albumin concentration was lower than that in the non-SSI group,and the incidence of abdominal complications was higher than that in the non-SSI group,with statistically significant differences(P<0.05).Age(>65 years),underlying disease,malignancy,postoperative blood transfusion,low postoperative albumin(≤40 g/L)and abdominal complications were independent risk factors for the occurrence of SSI(P<0.05).Subject working curves showed that the area under the curve of the scoring system predicting the occurrence of SSI was 0.825(P<0.05).Conclusion:Age,underlying disease,malignancy,postoperative blood transfusion,low postoperative albumin,and abdominal complications are all independent risk factors for the occurrence of SSI.Clinicians should accurately assess the specific physiological status of PD patients in the future,and take timely and appropriate targeted interventions for those with risk factors for SSI to reduce their risk of SSI occurrence.