结肠与直肠癌患者手术部位感染的危险因素

Risk factors of surgical site infection in patients with colon or rectal cancer

摘要:

目的了解结肠和直肠癌患者手术部位感染（SSI）的发生情况及其危险因素。方法前瞻性监测某院2008年1月1日—2013年12月31日所有诊断为结肠或直肠癌并进行急诊或择期手术的患者。收集患者一般资料、手术情况、抗菌药物使用情况，术后每日观察并随访患者SSI发生情况，并采用单因素及多因素分析方法分析其SSI危险因素。结果共监测694例结肠癌与直肠癌手术患者，其中结肠癌380例，直肠癌314例；发生SSI 125例，包括15例切口感染和110例器官/腔隙感染，SSI发病率为18.01%；结肠癌手术患者SSI发病率为17.11%（65/380），直肠癌手术患者SSI发病率为19.11%（60/314）。单因素分析结果显示，结肠癌手术患者中围手术期有其他部位感染、基础疾病、癌症Ⅰ期、实施减张缝合的患者SSI发病率较高（均P＜0.05）；直肠癌手术患者中围手术期有其他部位感染、基础疾病、梗阻、手术时间＞2 h、造口、引流、减张缝合、术中冲洗、使用抗菌药药物＞72 h的患者SSI发病率较高（均P＜0.05）。logistic回归分析结果显示，结肠癌患者SSI的独立危险因素为基础疾病、围手术期有其他部位感染、减张缝合（均P＜0.05）；直肠癌患者SSI的独立危险因素为基础疾病、围手术期有其他部位感染、造口（均P＜0.05）。结论应针对结肠癌与直肠癌手术患者SSI的危险因素采取预防与控制措施，尤其是有慢性基础疾病及围手术期有其他部位感染的患者；结肠癌患者还应重点关注减张缝合，直肠癌患者还应关注造口。

关键词:

结肠癌;直肠癌; 手术部位感染;医院感染; 危险因素

Abstract:

ObjectiveTo investigate the occurrence and risk factors of surgical site infection (SSI) in patients with colon or rectal cancer.MethodsPatients who were diagnosed with colon or rectal cancer and underwent emergency or elective surgery in a hospital between January 1, 2008 and December 31, 2013 were monitored prospectively. General data, operation condition, and antimicrobial use of patients were analyzed, occurrence of SSI was observed every day and followed up after operation, risk factors of SSI were analyzed by univariate and multivariate analysis. ResultsA total of 694 patients with colon cancer(n=380) or rectal cancer(n=314) were monitored, SSI occurred in 125 patients, including 15 incisional infection and 110 organ/space infection, incidence of SSI was 18.01%；incidence of SSI in colon cancer patients and rectal cancer patients were 17.11% (65/380) and 19.11%（60/314）respectively. Univariate analysis showed that among colon cancer patients, incidence of SSI was higher in those with coinfection of other sites during perioperative period, underlying diseases, phase Ⅰcancer, and relaxation suture(all P<0.05); among rectal cancer patients, incidence of SSI was higher in those with coinfection of other sites during perioperative period, underlying diseases, obstruction, operation time>2 hours, stoma, drainage, relaxation suture, rinsing during operation, and use of antimicrobial agents>72 hours (all P<0.05); logistic regression analysis showed that the independent risk factors for SSI in colon cancer patients were underlying disease, coinfection of other sites during perioperative period, and relaxation suture(all P<0.05); independent risk factors for SSI in rectal cancer patients were underlying disease, coinfection of other sites during perioperative period, and stoma(all P<0.05). ConclusionPrevention and control measures should be taken according to risk factors of SSI in patients undergoing colon cancer and rectal cancer surgery, especially those who with chronic underlying diseases and other site infection during perioperative period; in addition, patients with colon or rectal cancer should also pay attention to relaxation suture and stoma respectively.

Key words:

colon cancer; rectal cancer; surgical site infection; healthcareassociated infection; risk factor