引流液异常对胃肠肿瘤术后腹盆腔感染性并发症的早期预测作用

Drainage in the first postoperative days predicts intra-abdominopelvic complications

目的 探索胃肠肿瘤患者术后早期阶段腹盆腔引流液对于腹盆腔感染性并发症的早期预测作用.方法 前瞻性观察评价北京大学肿瘤医院胃肠肿瘤中心一病区2017年4-9月符合纳入标准的207例胃癌、结直肠癌手术患者术后早期阶段(术后4 d以内)腹盆腔引流液情况,其中男性159例(76.8％),女性48例(23.2％);平均年龄(59.9±10.6)岁,平均体重指数(23.7±3.2) kg/m2.结合其临床资料信息(如术后并发症登记及Clavien-Dindo分级结果),比对分析引流液异常与腹盆腔感染性并发症的关系.符合正态分布的连续变量资料采用均数±标准差(x±s)表示,分类变量资料采用数量及百分比表示,并采用x2检验及Fisher精确检验.结果 207例患者中,199例(96.1％)患者术后早期阶段引流液评价为“正常”,8例(3.9％)评价为“异常”(如引流液浑浊或有异味).有53例(25.6％)患者被诊断有术后并发症.引流液正常患者中,45例(22.6％)被诊断有术后并发症,而8例(100.0％)引流液异常的患者均被诊断有术后并发症,主要为吻合口漏等腹盆腔感染性并发症及腹腔出血,引流液异常的患者术后并发症发生率明显高于引流液正常的患者,分别是100.0％和22.6％,差异明显具有统计学意义(P =0.000 012).此外,8例引流液异常患者中,7例(87.5％)并发症的诊断时间在手术3 d以后,1例(12.5％)胃癌患者术后第4天引流液评价为“异常”,术后消化道造影、腹部B超等检查均无异常发现,住院期间末被诊断有并发症,后于出院30 d内2次出现腹盆腔感染性并发症而再入院治疗.结论 胃肠手术后早期阶段引流液性状或气味改变是高度特异的预警指标,有助于腹盆腔感染性并发症的早期诊断.应优化临床路径,采用更加规范的登记管理模式保证包括引流液性质、术后并发症等在内的患者相关临床信息的及时记录,并对引流液异常的患者采取较为积极的预防干预措施.

Objective To explore the feasibility of early predicting intra-abdominopelvic infectious complications by closer observation of abdominal drainage.Methods Prospectively collected and evaluated the first-three-postoperative-day drainage samples of 207 up-to-standard patients underwent gastrointestinal surgery between April and September 2017 in Peking University Cancer Hospital.Among them,159 males (76.8％) and 48 females (23.2％) were included,the average age was (59.9 ± 10.6) years and the average body mass index was (23.7 ± 3.2) kg/m2.Characteristics of the samples were daily recorded and later on matched with the clinical outcomes,including complications recorded and graded according to the Clavien-Dindo classification.The measurement data with normal distribution were presented as mean and standard deviation,the enumeration data were recorded in the form of quantity and percentage,using the x2 test and Fisher accurate test.Results One hundred and ninty-nine patients (96.1％) were recorded as normal in the drainage samples,while the other 8 cases (3.9％) as abnormal (including pungent odor,purulent color etc.).There were 53 patients (25.6％) were diagnosed with postoperative complications.Among the patients with normal samples,the complication rate was 22.6％,while the eight abnormal ones were all diagnosed with postoperative complications (complication rate:100.00％,P =O.000 012).Notably,among those 8 cases,complications were diagnosed much later than 3 days after surgery in 7 (87.5％) patients.In 1 (12.5％) case,the drainage abnormality was the only abnormal signs and there was no complications detected during the postoperative period of hospitalization.The intra-abdominal infectious complication occurred within 30 days after discharge and the patient re-admitted two times.Conclusions Early change of basic characteristics of postoperative drainage is a promising candidate for detection of postoperative complications with strong specificity.Clinical practice should be further regulated to ensure in-time recording and following interventions of those signs.