肝细胞癌切除术后影响手术部位感染的危险因素

目的探讨影响肝细胞癌(简称肝癌)切除术后手术部位感染的危险因素。方法选取2012年2月至2018年2月在四川大学华西医院肝脏外科行肝癌切除术的患者1 319例作为研究对象,收集、分析患者围术期临床资料,探讨影响术后手术部位感染的独立危险因素。结果 1 319例行肝癌切除术的患者中,82例(6.2%)发生手术部位感染,其中表浅切口感染37例(2.8%),深部切口感染16例(1.2%),器官/腔隙感染29例(2.2%)。围术期空腹血糖>6.1mmol/L、手术时间、术中出血量、术后胆漏是影响手术部位感染发生的独立危险因素。肝癌切除范围明显影响手术部位感染(P<0.05),以及器官/腔隙感染(P<0.05)。手术部位感染明显影响住院时间(P<0.05)和围术期病死率(P=0.021)。结论围术期血糖控制情况、手术时间、术中失血量、术后胆漏是影响手术部位感染的独立危险因素。肝癌切除范围明显影响手术部位感染,特别是影响器官/腔隙感染的独立危险因素。手术部位感染导致住院时间延长,围术期病死率升高。

Risk factors of surgical site infection after surgery of hepatocellular carcinoma

Objective To discuss the risk factors for surgical site infection(SSI)after hepatectomy.Methods A total of 1 319 patients with hepatocellular carcinoma(HCC)treated between February 2012 to February 2018 in West China Hospital were selected.Preoperative,intraoperative,and postoperative variables were analyzed to identify risk factors for SSI.Results In a total of 1 319 patients,82 patients(6.2%)after hepatectomy suffered SSI,in which,superficial incision infection were 37 cases(2.8%),deep incision infection were 16 cases(1.2%),organ/space infection were 29 cases(2.2%).Perioperative fasting blood glucose higher than 6.1 mmol/L,long operative time,mass intraoperative blood loss and bile leakage were the risk factors of SSI.Scope of hepatectomy obviously influenced SSI(P<0.05),as well as on organ/space infection(P<0.05).SSI suffered significantly longer hospitalization(P<0.05),higher perioperative period mortality(P=0.021).Conclusion Perioperative fasting blood glucose range,operative time,blood loss,bile leakage are identified as independent risk factors for SSI in patients undergoing liver resection.Scope of hepatectomy obviously has influenced on SSI,particularly on organ/space infection.SSI has led to the longer hospitalization and higher mortality.