检索历史 清除

目的 分析腹腔镜胆囊切除术(LC)术后切口感染的危险因素,为预防LC术后切口感染提供参考.方法 回顾性分析2003年1月至2015年12月行LC的4042例患者,探讨引发术后切口感染的原因,并通过对人口学资料、术前患者病史、手术情况等进行多因素Logistic回归分析以确定LC术后切口感染的危险因素.结果 4042例行LC患者中共有291例术后出现切口感染,感染率为7.2%.通过多变量分析确定切口部位感染主要危险因素如下:附加手术(让步比OR 4.011,95%CI 2.149~7.486)、年龄>55岁(OR 2.398,95%CI1.777~3.235)、中转开腹(让步比OR 2.647,95%CI 1.935~3.621)、术后血肿(OR1.910,95%CI 1.192~3.060)、手术时间>60 min(OR 2.493,95%CI 1.710~3.635)、胆囊管残端不足(OR12.451,95%CI 4.169~37.189)、胆囊穿孔(OR 6.161,95%CI 2.365~16.047)、胆囊积脓(OR1.704,95%CI 1.080~2.689)和二次手术(OR15.725,95%CI 10.439~23.686).其中,LC术后切口感染与延长住院时间(P<0.01)、增大术后死亡率(P<0.01)、增加手术返修率(P<0.01)具有显著相关性.结论 附加手术是LC术后切口感染的一个重大危险因素.此外,手术时间>60 min、年龄>55岁、中转开腹、胆囊管残端不足、术后血肿、胆囊穿孔、胆囊积脓以及二次手术均为LC术后切口感染的独立风险因素.对于具有上述风险因素的行LC术患者,应当积极采取措施预防LC术后切口感染的发生.

Objective To identify the risk factors for surgical site infections after operation of laparoscopic cholecystectomy (LC), so as to provide warning signs for preventing such incidents. Methods The data of 4042 LC patients from January 2003 to December 2015 were analyzed retrospectively. The risk factors for surgical site infections were identified among demographic data, preoperative patients′history, and operative data using multivariate Logistic regression analysis. Results Surgical site infections after LC was seen in 7.2% (291/4042) of the patients. Multivariate analysis identified the following parameters as risk factors for surgical site infections: additional surgical procedure ( OR 4.011, 95%CI 2.149-7.486), age over 55 years (OR 2.398, 95%CI 1.777-3.235), conversion to open procedure (OR 2.647, 95%CI 1.935-3.621), postoperative hematoma (OR 1.910, 95%CI 1.192-3.060), duration of operation >60 min (OR 2.493, 95%CI 1.710-3.635), cystic stump insufficiency (OR 12.451, 95%CI 4.169-37.189), gallbladder perforation (OR 6.161, 95%CI 2.365-16.047), gallbladder empyema (OR 1.704, 95%CI 1.080-2.689), and surgical revision (OR 15.725, 95%CI 10.439-23.686). Surgical site infections were associated with a significantly prolonged hospital stay (P<0.01), higher postoperative mortality (P<0.01), and increased rate of surgical revision (P<0.01). Conclusions Additional surgical procedure is identified as a strong risk factor for surgical site infections after LC. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for surgical site infections after LC.