摘要
目的探讨肝门部胆管癌术后医院感染的预测因素。方法回顾性分析2013年1月至2019年12月于福建医科大学附属第一医院手术治疗的243例肝门部胆管癌病人的临床资料,根据术后是否出现感染分为感染组和非感染组,对比两组病人的一般临床资料、治疗、手术及术后并发症等情况。观察术后感染病人病原学特点,采用单因素分析及多因素Logistic分析探究肝门部胆管癌术后发生医院感染的预测因素。结果243例肝门部胆管癌病人中术后发生医院感染45例,感染率18.52%,术后感染病人临床送检标本共培养病原菌62株,其中革兰阴性菌45株(72.58%),以大肠埃希菌为主,革兰阳性菌13株(20.97%),真菌4株(6.45%)。肝门部胆管癌病人术后发生医院感染的预测因素为:术前合并糖尿病、肝内胆管结石、黄疸、胆道感染,手术合并肝切除、手术时间长、术中出血量大、术中输血、中心静脉置管时间长、留置导尿管时间长,术后胆漏。多因素Logistic回归分析显示:术前胆红素高、糖尿病、术中出血量多、术中输血、术后出现胆漏是术后医院感染的独立预测因素。结论肝门部胆管病人术前胆红素高、糖尿病、术中出血量多、术中输血、术后出现胆漏可作为肝门部胆管癌术后医院感染的独立预测因素。
Objective To explore the predictors of postoperative nosocomial infection of surgery for hilar cholangiocarcinoma.Methods From January 2013 to December 2019,clinical data of 243 surgical patients with hilar cholangiocarcinoma were retrospectively analyzed.According to whether or not postoperative infection occurred,they were divided into infected and non-infected groups.General profiles,treatments,surgical approaches and postoperative complications of two groups were compared.For observing the etiological characteristics,univariate and multivariate Logistic analysis were employed for exploring the risk factors for nosocomial infection after surgery for hilar cholangiocarcinoma.Results Forty-five patients with hilar cholangiocarcinoma developed nosocomial infection with an infection rate of 18.52%.And 62 strains of pathogenic bacteria and 45 strains of Gram-negative bacteria(72.58%)were cultured.Escherichia coli dominated and there were 13 strains of Gram-positive bacteria(20.97%)and 4 strains of fungi(6.45%).Preoperative diabetes mellitus,intrahepatic cholelithiasis,jaundice,biliary tract infection,concurrent hepatectomy,long operative duration,intraoperative hemorrhage,intraoperative blood transfusion,central vein catheterization,long indwelling catheterization time and postoperative bile leakage were the predictors of postoperative hospital infection.Multivariate logistic regression analysis indicated that preoperative elevation of bilirubin,diabetes mellitus,intraoperative loss of blood volume,intraoperative volume of blood transfusion and postoperative bile leakage were the independent predictors of postoperative infection.Conclusion Preoperative elevation of bilirubin,diabetes mellitus,intraoperative hemorrhage,intraoperative volume of blood transfusion and postoperative bile leakage are independent predictors of postoperative hospital infection.
作者
连伟
王亮
欧荣文
丁法典
石铮
陈有挺
Lian Wei;Wang Liang;Ou Rongwen;Ding Fadian;Shi Zheng;Chen Youting(Department of Hepatobiliary&Pancreatic Surgery,First Affiliated Hospital,Fujian Medical University,Fujian Research Institute of Abdominal Surgery,Fujian Fuzhou 350005,China)
出处
《腹部外科》
2021年第2期144-148,共5页
Journal of Abdominal Surgery
基金
福建省卫生计生中青年骨干人才培养项目(2018-ZQN-44)。
关键词
肝门部胆管癌
手术
医院感染
预测因素
Hilar cholangiocarcinoma
Operation
Nosocomial infection
Predictors
