腹股沟疝无张力修补术手术部位感染危险因素

Risk factors for surgical site infection after tension-free mesh inguinal hernia repair

摘要:

目的 探讨腹股沟疝无张力修补术后手术部位感染（SSI）的危险因素。方法 采用1：4配对病例对照研究，以2016年1月—2018年6月在复旦大学附属华东医院普通外科接受Ⅰ类切口腹股沟疝无张力修补术患者中发生术后SSI的25例患者作为病例组，按年龄、性别和手术日期匹配接受Ⅰ类切口腹股沟疝无张力修补术但术后未发生SSI的100例患者作为对照组，应用SPSS 16.0软件进行单因素和多因素配对logistic回归分析。结果 共收集1 648例接受Ⅰ类切口腹股沟疝无张力修补术的患者，发生术后SSI的患者共25例，SSI发生率为1.52%。合并糖尿病、高血压、呼吸系统疾病、恶性肿瘤等基础疾病和术前住院时间长是腹股沟疝无张力修补术发生SSI的危险因素，OR值分别为12.686、3.326：围手术期预防性使用抗菌药物与否、植入补片类型、腹腔镜手术与否、患者吸烟史等因素在导致术后发生SSI方面差异均无统计学意义（均P>0.05）。结论 合并糖尿病、高血压、呼吸系统疾病、恶性肿瘤等基础疾病可增加腹股沟疝无张力修补术发生SSI的风险，缩短术前住院时间可降低修补术发生SSI的风险。

Abstract:

Objective To explore the risk factors for surgical site infection (SSI) after tension-free mesh inguinal hernia repair(TFMIHR). Methods A 1:4 matched case-control study was conducted, 25 patients with postoperative SSI after class I incision TFMIHR in the general surgery department of Huadong Hospital Affiliated to Fudan University from January 2016 to June 2018 were selected as case group, 100 patients who received class I incision TFMIHR but didn't develop SSI after operation were selected as control group according to matching of age, gender and operation date, SPSS 16.0 software was used for univariate analysis and paired multivariate logistic regression analysis. Results A total of 1 648 patients who underwent class I incision TFMIHR were collected, 25 patients suffered from SSI after operation, incidence of SSI was 1.52%. Risk factors for SSI after TFMIHR were diabetes mellitus, hypertension, respiratory system disease, malignant tumor and long duration of hospital stay before operation, OR value was 12.686 and 3.326 respectively; there was no significant difference in the occurrence of SSI after operation in patients who used perioperative prophylactic antimicrobial agents or not, types of mesh, laparoscopic surgery or not, and smoking history(all P<0.05). Conclusion Patients suffering from underlying diseases such as diabetes mellitus, hypertension, respiratory system disease, malignant tumor can increase the risk of SSI after TFMIHR, shortening of preoperative hospitalization time can reduce the risk of SSI after TFMIHR.