皮下负压引流装置预防下消化道开放手术浅表切口手术部位感染的疗效

Efficacy of subcutaneous negative pressure drainage device in the prevention of surgical site infections of superficial incisions in the open surgery of the lower gastrointestinal tract

目的探讨皮下负压引流装置在预防下消化道开放手术浅表切口手术部位感染(SSI)中的作用。方法收集2018年10月—2020年6月在首都医科大学附属北京友谊医院行下消化道开放手术的104例患者的病例资料,并应用倾向性评分匹配(PSM)研究。收集2021年2~12月在首都医科大学附属北京友谊医院行下消化道开放手术的104例患者的病例资料,并进行随机对照试验(RCT)研究。采用χ^(2)检验分析皮下负压引流装置与浅表切口SSI的关系,采用单因素和多因素Logistic回归分析明确浅表切口SSI的危险因素。结果两组研究均提示应用皮下负压引流装置的患者术后发生浅表切口SSI明显较少(PSM研究:P=0.007;RCT研究:P=0.049)。在PSM研究中,通过单因素和多因素Logistic回归分析,结果显示,未放置皮下负压引流装置(P_(uni)=0.012,P_(multi)=0.009)及术后吻合口漏(P_(uni)=0.054,P_(multi)=0.034)均为浅表切口SSI的独立危险因素。在RCT研究中,通过单因素和多因素Logistic回归分析,结果显示,未放置皮下负压引流装置(P_(uni)=0.061,P_(multi)=0.017)、高龄(P_(uni)=0.076,P_(multi)=0.032)和长切口(P_(uni)=0.078,P_(multi)=0.040)为浅表切口SSI的独立危险因素。结论皮下负压引流装置可显著减少下消化道开放手术浅表切口SSI。

Objective To investigate the role of subcutaneous negative pressure drainage device in the prevention of surgical site infections(SSI)of superficial incisional in lower digestive tract open surgeries.Methods Clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital,Capital Medical University from October 2018 to June 2020 was analyzed by a propensity score matching(PSM),and the clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital,Capital Medical University from February to December 2021 was analyzed by a randomized controlled trial(RCT).Chi-square tests were conducted to analyze the association of subcutaneous negative pressure drainage device with SSI of superficial incisional.Univariate and multivariate Logistic regression analysis were used to identify the risk factors for SSI in superficial incisions.Results Patients with subcutaneous negative pressure drainage device encounter significantly less SSI of superficial incisional in both the PSM study(P=0.007)and the RCT study(P=0.049).In the PSM study,the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage(P_(uni)=0.012,P_(multi)=0.009)and postoperative anastomosis leak(P_(uni)=0.054,P_(multi)=0.034).In the RCT study,the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage(P_(uni)=0.061,P_(multi)=0.017),eldly(P_(uni)=0.076,P_(multi)=0.032),long incision(P_(uni)=0.078,P_(multi)=0.040).Conclusion Subcutaneous negative pressure drainage device can significantly reduce SSI of superficial incisional in lower digestive tract open surgeries.