胃癌根治术后手术部位感染的影响因素

Influencing Factors of Surgical Site Infection After Radical Gastrectomy

目的探究胃癌根治术后手术部位感染(SSI)的影响因素。方法研究对象来源于2021年1月1日至2022年12月31日郑州大学第一附属医院2175例腹腔镜胃癌根治术患者,统计患者SSI发生率,监测SSI患者胃部细菌菌落分布情况,流式细胞仪检测患者外周血CD36表达,蛋白免疫印迹法检测外周血T细胞中雷帕霉素靶蛋白1(mTORC1)表达,分析胃癌根治术后SSI发生的危险因素,并建立logistic危险因素的预测模型。结果2175例腹腔镜胃癌根治术患者,术后32例发生SSI,感染率1.5%(32/2175),切口浅部感染、切口深部感染、器官腔隙感染各占12.50%(4/32)、37.50%(12/32)、50.00%(16/32)。经病原菌培养共检出58株,其中革兰阳性菌16株(27.59%),革兰阴性菌42株(72.41%),金黄色葡萄球菌、大肠埃希杆菌、铜绿假单胞菌是胃癌根治术后SSI主要致病菌。SSI组年龄≥60岁、手术时间>60 min、未预防性使用抗菌药物、术后卧床时间>3 d占比高于无SSI组,且SSI组外周血CD36、mTORC1及CD36/mTORC1比值高于无SSI组(P<0.05)。年龄、手术时间、未预防性使用抗菌药物、术后卧床时间、CD36/mTORC1是胃癌根治术后SSI发生的影响因素(P<0.05)。危险因素预测模型预测胃癌根治术后SSI发生的曲线下面积为0.900,敏感度为87.6%,特异度为89.5%,较单项检测的高。结论胃癌根治术后SSI患者胃部细菌以革兰阴性菌为主,预防性使用抗菌药物、控制手术时间、术后卧床时间等是预防SSI发生的有效策略,而外周血CD36/mTORC1通路蛋白表达对术后SSI风险的评估有积极作用。

Objective To explore the influencing factors of surgical site infection(SSI)after radical gastrectomy.Methods Totally 2175 patients undergoing radical gastrectomy for gastric cancer in the First Affiliated Hospital of Zhengzhou University were selected as study subjects between January 1,2021 to December 31,2022.The incidence of SSI was counted,and the distribution of gastric bacterial colonies in patients with SSI was monitored.The expression of CD36 in peripheral blood of patients enrolled was detected by flow cytometry,and mechanistic target of rapamycin complex 1(mTORC1)expression in peripheral blood T cells was detected by western blotting.The risk factors of SSI after radical gastrectomy for gastric cancer were analyzed,and a prediction model of logistic risk factors was established.Results Among the 2175 patients undergoing laparoscopic radical gastrectomy,32 cases developed SSI after surgery,with an infection rate of 1.5%(32/2175).Superficial incision infection,deep incision infection and organ space infection accounted for 12.50%(4/32),37.50%(12/32)and 50.00%(16/32),respectively.A total of 58 strains were detected in the culture of pathogenic bacteria,of which 16(27.59%)were Gram-positive and 42(72.41%)were Gram-negative.Staphylococcus aureus,Escherichia coli and Pseudomonas aeruginosa were the main pathogens causing SSI after radical gastroctomy.The percentages of age≥60 years old,operation time>60 minutes,no prophylactic use of antibiotics and postoperative bed time>3 days in SSI group were higher than those in SSI group,and the ratios of CD36,mTORC1 and CD36/mTORC1 in peripheral blood in SSI group were higher than those in SSI group(P<0.05).Age,operation time,non-prophylactic use of antibiotics,postoperative bed time,and CD36/mTORC1 were the factors influencing the occurrence of SSI after radical gastrectomy(P<0.05).The risk factor prediction model predicted SSI occurrence after radical gastroctomy with an area under the curve of 0.900,a sensitivity of 87.6%and a specificity of 89.5%,which was higher than that of single detection.Conclusion Gram-negative bacteria are main pathogenic bacteria of SSI after radical gastrectomy.Preventive use of antibacterial drugs and control of operation time and postoperative time in bed may reduce the risk of SSI.Meanwhile,CD36/mTORC1 pathway protein in peripheral blood should be actively monitored to help risk assessment of postoperative SSI in patients.