成人腹股沟疝无张力修补术后切口感染分析

目的探讨成人腹股沟疝无张力疝修补术后切口感染的高危因素和预防方式。 方法回顾性分析2016年10月至2018年5月，火箭军总医院226例腹股沟疝患者的临床资料，本组患者均行无张力疝修补术。分析术后切口感染情况，及引起术后感染的相关因素。 结果患者均顺利完成手术，切口感染患者18例（7.96%）。急性嵌顿疝患者用过补片与未用过补片感染情况比较，差异有统计学意义（P<0.05）；围手术期预防性使用抗生素与否对切口感染影响明显，且差异有统计学意义（P<0.05）；患者自身因素、术前切口的微环境和手术操作对切口感染不明显，差异无统计学意义（P>0.05）。术后手术部位感染病原体培养，病原体分离革兰阳性菌11株（61.11%），革兰阴性菌7株（38.89%），白色念珠菌感染1株（5.56%）。药敏试验结果显示金黄色葡萄球菌为代表的革兰阳性菌对青霉素类和磺胺甲噁唑/甲氧苄啶呈较高的耐药率，以鲍曼不动杆菌为代表的革兰阴性菌普遍对氨苄西林的耐药率较高；白色念珠菌对咪康唑耐药率100%，对氟康唑、伊曲康唑、益康唑和制霉菌素耐药率均为0。 结论预防腹股沟疝无张力疝修补术后切口感染的重点在于针对不同高危因素采取有效的预防措施，术后感染期选择适合抗生素进行治疗。

Analysis of wound infection after tension-free inguinal hernia repair in adults

ObjectiveTo investigate the risk factors and prevention of incision infection after tension-free repair of inguinal hernia in adults. MethodsA retrospective analysis was performed on 226 patients with inguinal hernia admitted to General Hospital of the PLA Rocket Force from October 2016 to May 2018, who underwent tension-free hernia repair. ResultsAll patients were successfully operated, and 18 patients (7.96%) were infected with the incision. The infection developed in patients with acute incarcerated hernia who used mesh and didn’t use patch were compared, and the difference was statistically significant (P<0.05). The prophylactic use of antibiotics during perioperative period had significant effects on wound infection, and the difference was statistically significant (P<0.05); the patient's own factors, the microenvironment of the preoperative incision and the surgical operation were not significant for the infection (P>0.05). In 226 cases, 11 cases (61.11%) of gram-positive bacteria were isolated from the pathogens of surgical site infection, 7 strains of gram-negative bacteria (38.89%), and 1 candida albicans infection. Gram-positive bacteria represented by staphylococcus aureus showed high drug resistance rate to penicillin and sulfamethoxazole/trimethoprim, and gram-negative bacteria represented by acinetobacter baumannii generally showed high drug resistance rate to ampicillin. Candida albicans was resistant to fluconazole and miconazole; the resistance rate of Candida albicans to miconazole was 100%, and the resistance rate to fluconazole, itraconazole, econazole and nystatin was 0. ConclusionThe key to prevent incision infection after tension-free repair of inguinal hernia is to take effective preventive measures according to different risk factors and appropriate antibiotic should be adopted in postoperative infection period.