根治性膀胱癌切除术后感染切口愈合的危险因素

目的探究根治性膀胱癌切除术后感染切口愈合的危险因素及与单核淋巴细胞因子的关系。方法回顾性选取2015年1月-2018年12月于南阳市中心医院泌尿外科接受根治性膀胱癌切除术治疗的患者作为研究对象,共200例,根据术后切口是否发生感染分为感染组(n=100)和未感染组(n=100),其中感染组根据切口愈合时间分为早期愈合组(n=65)和延迟愈合组(n=35)。对影响根治性膀胱癌切除术后感染切口愈合的因素进行单因素和多因素Logistic回归分析;比较感染组和未感染组血清单核淋巴细胞水平。结果延迟愈合组患者术中出血量高于早期愈合组,白蛋白含量低于早期愈合组,手术时间长于早期愈合组,尿瘘、肠瘘次数均高于早期愈合组(均P<0.05)。经Logistic回归分析,白蛋白、术中出血量、手术时间、尿瘘、肠瘘是影响患者感染切口愈合的独立危险因素(P<0.05)。切口感染组血清肿瘤坏死因子-α(TNF-α)、粒细胞集落刺激因子(G-CSF)、白细胞介素-8(IL-8)、IL-4、IL-6水平高于未感染组(均P<0.05),而IL-2水平低于未感染组(P<0.05)。结论白蛋白、术中出血量、手术时间、尿瘘、肠瘘是影响患者感染切口愈合的独立危险因素,在临床上应采取有针对性的预防控制措施,避免影响术后切口的愈合。同时,对单核淋巴细胞因子的检测有助于防治术后切口感染的发生。

Risk factors for healing of postoperative incision infection in radical bladder cancer resection patients

OBJECTIVE To explore the risk factors for healing of postoperative incision infection in the radical bladder cancer resection patients and analyze their association with mononuclear and lymphocyte factors.METHODS Totally 200 patients who underwent radical bladder cancer resection in department of urology of Nanyang Central Hospital from Jan 2015 to Dec 2018 were recruited as the study objects and divided into the infection group with 100 cases and the non-infection group with 100 cases according to the status of postoperative incision infection,and the patients of the infection group wee divided into the early healing group with 65 cases and the delayed healing group with 35 cases according to the incision healing time.Univariate analysis and multivariate logistic regression analysis were performed for the factors for healing of postoperative incision infection in the radical bladder cancer resection patients,and the levels of serum mononuclear lymphocytes were compared between the infection group and the non-infection group.RESULTS The intraoperative blood loss volume of the delayed healing group was significantly higher than that of the early healing group,the albumin level of the delayed healing group was significantly lower than that of the early healing group,the operation duration of the delayed healing group,and the number of times of urinary fistula and intestinal fistula was significantly higher in the delayed healing group than in the early healing group(all P<0.05).The logistic regression analysis showed that albumin,intraoperative blood loss volume,operation duration,urinary fistula and intestinal fistula were the independent risk factors for the healing of incision infection(P<0.05).The levels of serum tumor necrosis factor-α(TNF-α),granulocyte colony stimulating factor(G-CSF),interleukin-8(IL-8),IL-4 and IL-6 of the infection group were significantly higher than those of the non-infection group(all P<0.05),while the IL-2 level of the infection group was significantly lower than that of the non-infection group(P<0.05).CONCLUSION The albumin,intraoperative blood loss volume,operation duration,urinary fistula and intestinal fistula are the independent risk factors for the healing of incision infection.It is necessary for the hospital to take targeted prevention measures and avoid the influencing factors for healing of the postoperative incision,meanwhile,the detection of monocytes and lymphocyte factors is helpful to prevent and treat the postoperative incision infection.