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结直肠癌术后手术部位切口感染的预后因素分析

Prognostic factors of postoperative incisional surgical site infections for colorectal cancer

摘要:

目的 探讨结直肠癌术后手术部位切口感染(I-SSI)的预后因素.方法 回顾性分析2000年1月至2014年2月福建医科大学附属协和医院结直肠外科同一组医师实施手术治疗的连续2385例结直肠癌患者的临床资料.男性1421例,女性964例,平均年龄(59±13)岁.针对可能与I-SSI有关的各种因素进行单因素分析及多因素Logistic回归分析,筛选I-SSI的预后因素.结果 本组结直肠癌患者术后I-SSI的发生率为3.23% (77/2385).单因素及多因素分析结果显示,体重指数(OR=1.087,95% CI:1.023 ~1.155,P=0.007)、手术时间(OR=1.007,95% CI:1.002~1.012,P=0.006)、术前放化疗(OR=2.434,95% CI:1.099 ~ 5.393,P=0.028)及联合器官切除(OR=2.596,95% CI:1.060 ~6.357,P=0.037)是结直肠癌术后I-SSI的独立预后因素,腹腔镜手术是独立保护性预后因素(OR=0.386,95% CI:0.170 ~0.877,P=0.023).结论 体重指数、手术时间、术前放化疗及联合器官切除是结直肠癌患者术后I-SSI的独立预后因素,对具有上述预后因素的高危患者应该加强围手术期的个体化干预;而腹腔镜手术能够减少I-SSI的发生.

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abstracts:

Objective To explore the prognostic factors of postoperative incisional surgical site infections (I-SSI) for colorectal cancer.Methods Clinical data of 2385 colorectal cancer patients undergoing resection by the same surgical team in Department of Colon and Rectum Surgery,Fujian Medical University Union Hospital from January 2000 to February 2014 was analyzed retrospectively.There were 1421 male and 964 female patients,with a mean age of (59 ± 13) years.Univariate analysis and multivariate Logistic regression analysis were performed for independent prognostic factors of I-SSI.Results The I-SSI occurred in 77 patients (3.23%).The results of univariate analysis showed that there were statistical differences in body mass index (t =-3.356),operation time (t =-3.609),length of incision (t =-5.492),radical operation (X2 =8.963),laparoscopic surgery (X2 =25.884),combined evisceration (X2 =6.349) and intraoperative blood infusion (X2 =4.176) between two groups (all P <0.05).The results of multivariate Logistic regression analysis showed that independent prognostic factors of I-SSI were identified to be body mass index (OR =1.087,95%CI:1.023 to 1.155,P =0.007),operation time (OR =1.007,95% CI:1.002 to 1.012,P =0.006),preoperative chemoradiotherapy (OR =2.434,95% CI:1.099 to 5.393,P =0.028) and combined evisceration (OR =2.596,95% CI:1.060 to 6.357,P =0.037).The independent protective prognostic factor of I-SSI was identified to be the laparoscopic surgery (OR=0.386,95%CI:0.170 to 0.877,P=0.023).Conclusions Body mass index,operation time,preoperative chemoradiotherapy and combined evisceration are identified to be independent prognostic factors for I-SSI.High-risk patients should receive individualized perioperative intervention.Nevertheless,the laparoscopic surgery can decrease the incidence of I-SSI.

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作者: 郑晖 [1] 池畔 [2] 林惠铭 [2] 卢星榕 [2] 黄颖 [2] 蒋伟忠 [2] 徐宗斌 [2] 黄胜辉 [2] 孙艳武 [2]
第一作者: 郑晖
期刊: 《中华外科杂志》2016年54卷6期 424-428页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.06.006
发布时间: 2016-07-05
基金项目:
卫生部国家临床重点专科建设资助项目 National Clinical Key Specialty Construction Project (
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