CAJ | 학술논문

目的：探讨结直肠癌术后手术部位感染（ SSI ）的发生率及相关危险因素。方法回顾性分析浙江省嘉兴市第一医院2011年10月至2014年12月行结直肠癌手术患者的病历资料，包括性别、年龄、基础疾病、吸烟史、预防用药情况、是否有腹部手术史、手术类型、术前血红蛋白和白蛋白水平、是否使用腹腔镜、是否使用吻合器、是否行联合脏器切除术、TNM分期、美国麻醉医生协会（ ASA）评分等。采用多因素Logistic回归分析法分析结直肠癌患者外科手术后SSI发生的危险因素。结果共有773例患者被纳入研究，其中144例发生SSI，SSI的发生率为18.63％。多因素Logistic回归分析发现，使用腹腔镜（ OR＝0.35，95％CI：0.15～0.79，P＜0．05）、使用吻合器（ OR＝0.59，95％CI：0.39～0.88，P＜0．05）是患者发生SSI的保护性因素；而糖尿病（ OR＝2.11，95％CI：1.25～3.58，P＜0．01）、肝硬化（OR＝2.12，95％CI：1.18～3.79，P＜0．05）、ASA评分（3～4分）（OR＝2.01，95％CI：1.20～3.58，P＜0．01）、联合脏器切除（OR＝2.17，95％CI：1.20～3.92，P＜0．05）、吻合口瘘（OR＝6.85，95％CI：3.01～15.63，P＜0．01）是患者发生SSI的危险因素。结论结直肠癌术后SSI的发生率较高，为减少SSI的发生，建议在手术中使用腹腔镜和吻合器。
목적：탐토결직장암술후수술부위감염（ SSI ）적발생솔급상관위험인소。방법회고성분석절강성가흥시제일의원2011년10월지2014년12월행결직장암수술환자적병력자료，포괄성별、년령、기출질병、흡연사、예방용약정황、시부유복부수술사、수술류형、술전혈홍단백화백단백수평、시부사용복강경、시부사용문합기、시부행연합장기절제술、TNM분기、미국마취의생협회（ ASA）평분등。채용다인소Logistic회귀분석법분석결직장암환자외과수술후SSI발생적위험인소。결과공유773례환자피납입연구，기중144례발생SSI，SSI적발생솔위18.63％。다인소Logistic회귀분석발현，사용복강경（ OR＝0.35，95％CI：0.15～0.79，P＜0．05）、사용문합기（ OR＝0.59，95％CI：0.39～0.88，P＜0．05）시환자발생SSI적보호성인소；이당뇨병（ OR＝2.11，95％CI：1.25～3.58，P＜0．01）、간경화（OR＝2.12，95％CI：1.18～3.79，P＜0．05）、ASA평분（3～4분）（OR＝2.01，95％CI：1.20～3.58，P＜0．01）、연합장기절제（OR＝2.17，95％CI：1.20～3.92，P＜0．05）、문합구루（OR＝6.85，95％CI：3.01～15.63，P＜0．01）시환자발생SSI적위험인소。결론결직장암술후SSI적발생솔교고，위감소SSI적발생，건의재수술중사용복강경화문합기。
Objective To investigate the incidence and risk factors of surgical site infection ( SSI ) in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists ( ASA) score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases (18.63%).Multivariate logistic regression analysis showed that use of laparoscopy ( OR =0.35, 95%CI:0.15-0.79,P <0.05), use of stapler (OR =0.59, 95% CI: 0.39-0.88,P <0.05) were protective factors for SSI, while diabetes (OR=2.11, 95% CI: 1.25-3.58,P<0.01), liver cirrhosis (OR=2.12,95%CI:1.18-3.79,P<0.05), ASA score (3-4 points) (OR=2.01,95%CI:1.20-3.58, P<0.01), combined organ resection (OR=2.17,95% CI:1.20-3.92,P<0.05), and anastomotic leak (OR=6.85, 95%CI:3.01-15.63,P<0.01) were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .