CAJ | 학술논문

目的：分析结直肠癌患者术后切口感染的危险因素及防治措施，以降低直结肠癌手术切口感染率。方法回顾性分析2011年1月－2013年6月196例结直肠癌手术患者临床资料，其中腹腔镜手术30例、开腹手术166例，对术后发生切口感染患者的切口分泌物进行细菌培养及药敏试验，分析切口感染的危险因素，并提出相应的防治措施。结果196例患者中有38例发生切口感染，感染率为19．39％；共检出病原菌48株，其中革兰阴性菌28株占58．33％，革兰阳性球菌18株占37．50％，真菌2株占4．17％；革兰阴性菌对美罗培南、亚胺培南的敏感率均为100．00％；革兰阳性球菌对万古霉素、替考拉宁敏感率均为100．00％；真菌对氟康唑的敏感率为100．00％；回归分析显示开腹手术、手术时间＞150 min、术前抗菌药物使用＞3 d、合并糖尿病及体质量指数＞23 kg／m2是结直肠癌患者术后切口感染的危险因素（ P＜0．05）。结论结直肠癌术后切口感染因素复杂，临床应规范操作，减少开腹手术例数，缩短手术时间，术前1～3d预防性使用敏感的抗菌药物，改善饮食并积极控制患者体质量指数及血糖，以预防切口感染。
목적：분석결직장암환자술후절구감염적위험인소급방치조시，이강저직결장암수술절구감염솔。방법회고성분석2011년1월－2013년6월196례결직장암수술환자림상자료，기중복강경수술30례、개복수술166례，대술후발생절구감염환자적절구분비물진행세균배양급약민시험，분석절구감염적위험인소，병제출상응적방치조시。결과196례환자중유38례발생절구감염，감염솔위19．39％；공검출병원균48주，기중혁란음성균28주점58．33％，혁란양성구균18주점37．50％，진균2주점4．17％；혁란음성균대미라배남、아알배남적민감솔균위100．00％；혁란양성구균대만고매소、체고랍저민감솔균위100．00％；진균대불강서적민감솔위100．00％；회귀분석현시개복수술、수술시간＞150 min、술전항균약물사용＞3 d、합병당뇨병급체질량지수＞23 kg／m2시결직장암환자술후절구감염적위험인소（ P＜0．05）。결론결직장암술후절구감염인소복잡，림상응규범조작，감소개복수술례수，축단수술시간，술전1～3d예방성사용민감적항균약물，개선음식병적겁공제환자체질량지수급혈당，이예방절구감염。
OBJECTIVE To investigate the risk factors for postoperative incision infections in the patients with colo‐rectal cancer and put forward prevention measures so as to reduce the incidence of the incision infections . METHODS The clinical data of 196 colorectal cancer patients who underwent surgeries from Jan 2011 to Jun 2013 were retrospectively analyzed ,30 cases underwent the laparoscopic surgery ,and 166 cases received the laparoto‐my .The incision secretions were collected from the patients with postoperative incision infections for bacterial cul‐ture and drug susceptibility testing ;the risk factors for the incision infections were analyzed ,and the correspond‐ing prevention measures were put forward .RESULTS The incision infections occurred in 38 of 196 patients ,with the infection rate of 19 .39% .A total of 48 strains of pathogens have been isolated ,including 28 (58 .33% ) strains of gram‐negative bacteria ,18 (37 .50% ) strains of gram‐positive cocci ,and 2 (4 .17% ) strains of fungi .The drug susceptibility rates of the gram‐negative bacteria to meropenem and imipenem were 100 .00% ;the drug suscepti‐bility rates of the gram‐positive cocci to vancomycin and teicoplanin were 100 .00% ;the drug susceptibility rate of the fungi to fluconazole was 100 .00% .The regression analysis indicated that the risk factors for the postoperative incision infections in the colorectal cancer patients included the laparotomy ,operation duration more than 150 min , preoperative use of antibiotics for more than 3 days ,complication of diabetic mellitus ,and body mass index more than 23 kg/m2 (P<0 .05) .CONCLUSION The risk factors for the postoperative incision infections in the colorectal cancer patients are complex .It is necessary for the hospital to standardize the operation ,reduce the number of lap‐arotomy patients ,shorten the operation duration ,conduct sensitive antibiotics prophylaxis for 1 to 3 days before the surgery ,improve the diet ,and actively control the body mass index as well as the blood glucose so as to pre‐vent the incision infections .