目的:探讨结直肠癌术后手术部位感染( SSI )的发生率及相关危险因素。方法回顾性分析浙江省嘉兴市第一医院2011年10月至2014年12月行结直肠癌手术患者的病历资料,包括性别、年龄、基础疾病、吸烟史、预防用药情况、是否有腹部手术史、手术类型、术前血红蛋白和白蛋白水平、是否使用腹腔镜、是否使用吻合器、是否行联合脏器切除术、TNM分期、美国麻醉医生协会( ASA)评分等。采用多因素Logistic回归分析法分析结直肠癌患者外科手术后SSI发生的危险因素。结果共有773例患者被纳入研究,其中144例发生SSI,SSI的发生率为18.63%。多因素Logistic回归分析发现,使用腹腔镜( OR=0.35,95%CI:0.15-0.79,P<0.05)、使用吻合器( OR=0.59,95%CI:0.39-0.88,P<0.05)是患者发生SSI的保护性因素;而糖尿病( OR=2.11,95%CI:1.25-3.58,P<0.01)、肝硬化(OR=2.12,95%CI:1.18-3.79,P<0.05)、ASA评分(3-4分)(OR=2.01,95%CI:1.20-3.58,P<0.01)、联合脏器切除(OR=2.17,95%CI:1.20-3.92,P<0.05)、吻合口瘘(OR=6.85,95%CI:3.01-15.63,P<0.01)是患者发生SSI的危险因素。结论结直肠癌术后SSI的发生率较高,为减少SSI的发生,建议在手术中使用腹腔镜和吻合器。
Objective To investigate the incidence and risk factors of surgical site infection ( SSI ) in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists ( ASA) score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases (18.63%).Multivariate logistic regression analysis showed that use of laparoscopy ( OR =0.35, 95%CI:0.15-0.79,P 〈0.05), use of stapler (OR =0.59, 95% CI: 0.39-0.88,P 〈0.05) were protective factors for SSI, while diabetes (OR=2.11, 95% CI: 1.25-3.58,P〈0.01), liver cirrhosis (OR=2.12,95%CI:1.18-3.79,P〈0.05), ASA score (3-4 points) (OR=2.01,95%CI:1.20-3.58, P〈0.01), combined organ resection (OR=2.17,95% CI:1.20-3.92,P〈0.05), and anastomotic leak (OR=6.85, 95%CI:3.01-15.63,P〈0.01) were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .