剖宫产术后感染因素的分析

目的:探讨引起剖宫产术后感染危险因素.方法:2005年1月～2009年6月我院剖宫产切口感染2890产妇作为观察组;按照1∶2比例选择无剖宫术后感染的130产妇作为对照组,对可能影响术后感染因素进行单因素分析与Logistic回归分析.结果:剖宫产发生术后感染发生率为2.26%,单因素分析有16个与术后感染有关,非条件多因素分析结果筛选出5个主要的危险因素:BMI高、伴有生殖道感染、阴检次数多、术后预防应用抗生素、手术时间长.结论:剖宫产术后感染的发生率较高,与多种因素有关,通过控制体重指数、治疗原发感染病、阴检根据实际需要慎重选择、术前预防性应用抗生素、缩短手术时间等来预防和减少术后感染发生.     

术中区域性高浓度抗生素预防感染的研究

采用局部组织注射金黄色葡萄球菌制成创伤感染模型。实验组术中区域性高浓度注射抗生素，预防家兔肢体远端创伤后感染。对照组作为常规治疗。结果实验组无一肢体发生感染，对照组组织细菌培养有细菌生长，病理切片示急性炎性反应，且可见小脓肿。     

择期开腹结直肠手术单次预防性使用抗生素的安全性与有效性

目的探讨择期开腹结直肠手术单次预防性使用抗生素的安全性与有效性。方法回顾性分析2009年10月至2011年10月间在北京协和医院接受择期开腹结直肠手术的275例患者。所有患者于切皮前30～60min．单次静脉输注预防性抗生素。此后如无感染并发症则不再使用任何抗生素。根据术后手术部位感染、不明原因的抗生素治疗、肠道吻合口瘘以及远处感染的发生情况．综合判定为预防成功、预防失败或远处感染。结果275例患者术中和术后无一例发生抗生素相关的药物过敏反应。单次预防性使用抗生素预防成功率88．4％（243／275）,预防失败率8．4％（23／275）,远处感染9例（3．3％,9／275）。预防失败的23例中,手术部位感染13例（4．7％）,术后不明原因发热使用广谱抗生素者2例（0．7％）,术后发生肠道吻合口瘘8例（3．6％,8／222）。结论择期开腹结直肠手术单次预防性使用抗生素安全、有效。     

预防性口服抗生素在无张力疝修补的应用

目的探讨腹股沟疝术后应用口服抗生素对预防切口感染的影响。 方法回顾性分析2015年1至12月,广东省人民医院收治的306例择期行单侧腹股沟疝患者的临床资料,术后口服抗生素患者151例为试验组,选取同期未口服抗生素患者155例为对照组,观察2组术后切口感染发生情况。 结果所有疝手术患者均实施临床路径,术后随访时间1周,术后切口感染和对照组比较,差异无统计学意义（P>0.05）。 结论术后应用抗生素对腹股沟疝患者未能起到预防切口感染的作用。     

烧伤整形术后感染的危险因素与对策分析

目的:探讨烧伤整形术后感染的危险因素及预防对策。方法:选取烧伤整形术后感染者53例作为感染组及50例未感染者为对照组,分析术后感染的危险因素及预防对策。结果:多因素Logstic回归分析表明,联合使用2种及以上抗生素(OR=2.622,P0.05),手术时间≥200min(OR=2.800,P0.05),术后有瘢痕(OR=3.433,P0.05),术后有残余创面(OR=2.703,P0.05)均为烧伤整形术后院内感染的独立危险因素。烧伤整形术后感染的主要病原菌为金黄色葡萄球菌(26.42%)、铜绿假单胞菌(30.19%)及大肠埃希菌(20.75%)。结论:烧伤整形术后感染的危险因素主要包括抗生素使用种类过多、手术时间过长及瘢痕及残余创面,合理使用抗生素、缩短手术时间及消除瘢痕及残余创面可作为烧伤整形术后感染的预防对策。     

腹股沟疝无张力修补术预防性应用抗生素与否的随机对照研究

目的：探讨腹股沟疝无张力修补术是否需预防性应用抗生素。方法选择我院2011年7月至2013年8月行腹股沟疝无张力修补术128例进行前瞻性随机对照研究。预防性应用抗生素组（对照组）64例术前30 min 单次给予抗生素注射,未使用抗生素组（观察组）64例术前未给予抗生素治疗,对比两组术后切口感染的发生率。结果切口感染对照组1例（1．56％）,观察组2例（3．12％）,组间比较差异无统计学意义（P ＞0．05）。结论常规应用抗生素对于无高危因素的腹股沟疝无张力修补术预防术后手术部位感染并无实质必要。     

新式剖宫产围手术期预防性应用抗生素500例分析

目的探讨新式剖宫产预防性应用抗生素的临床效果。方法从我院新式剖宫产总人数中抽取500例作为研究组,术前30min开始静脉滴注抗生素,对照组为自1996年1月-2000年1月子宫下段剖宫产中抽取500例,手术将结束或术后开始静脉滴注抗生素,两组设定条件相同,具有可比性。结果研究组新式剖宫产预防性应用抗生素,且简化了手术步骤,手术时间短,术中出血少,组织损伤小,术后体温、住院时间、术后病率、术后切口感染均明显低于对照组子宫下段剖宫产,两者比较差异有统计学意义,P<0．05。结论新式剖宫产术前预防性应用抗生素,能有效地预防感染的发生,剖宫产各种术式中新式剖宫产应为首选,术前预防性应用抗生素同样适用于各类剖腹手术。     

急性结石性胆囊炎腹腔镜胆囊切除术预防性应用抗生素的疗效观察

目的:探讨急性结石性胆囊炎(ACC)患者腹腔镜胆囊切除术(LC)术前预防或不预防性使用抗生素的手术部位感染(SSI)率及发生SSI的可能危险因素。方法:选择2016年1月—2017年12月期间的符合纳入标准的行LC患者185例,采用随机数字表法分成观察组和对照组,观察组(93例)术前使用抗生素并且使用时间不超过24 h;对照组(92例)术前、术中、术后均不使用抗生素。术后观察两组患者的手术时间、住院时间,比较手术部位感染(SSI)情况。结果:5例中转开腹(观察组3例,对照组2例)不再纳入研究的范围,其余均顺利完成LC手术。两组手术时间与术后住院时间均无统计学差异(均P0.05);对照组发生感染3例(3.33%),分别为手术切口感染2例,腹腔感染1例,观察组发生感染2例(2.22%),均为手术切口感染;对照组发生全身感染1例(1.11%),观察组无全身感染发生。两组SSI与全身感染发生率的差异均无统计学意义(均P0.05)。结论:在ACC的LC手术中,术前不预防性使用抗生素并没有增加患者术后的感染率;术后出现感染的原因可能与患者年龄体质、胆囊坏疽破裂或取出困难、术前过度使用抗生素等有关。     

大肠癌术前不进行肠道准备的应用体会

【摘要】 目的 探讨不行肠道准备在大肠癌手术中的应用价值。方法 将2006年3月至2012年10月的80例择期大肠癌患者随机分成40例实验组和40例对照组,实验组手术前饮食不作限制,无肠道梗阻症状者可进普食,手术前1天可进半流质,手术前1天不给予抗生素肠道准备及机械性肠道准备;对照组手术前2天进半流质,手术前1天进全流,手术前1天22时开始禁食;术前1天口服庆大霉素和灭滴灵;有不全梗阻者予清洁灌肠;无梗阻者,口服清肠剂;围手术期预防性抗生素使用甲硝唑和头孢曲松。分析两组患者的术后恢复情况、术后并发症发生率及术后肠道菌群改变情况等。结果 实验组的术后切口感染肺部感染、腹腔脓肿、术后肠吻合口瘘的发生率及术后首次排气时间和住院时间与对照组相比,无显著性差异(P>0.05);但实验组术后低钠血症的发生率低于对照组,且术后肠道菌群改变明显低于对照组,差异有显著性(P<0.05)。结论 术前不进行肠道准备在大肠癌手术中是安全可行的。     

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目的探讨腹股沟疝无张力修补术是否需要常规预防性应用抗生素。方法按照随机对照的原则对2010年7月至2011年7月广东省人民医院血管甲状腺腹壁疝外科诊治842例成人腹股沟疝进行前瞻性研究分析。治疗组200例,术前一次性应用预防性抗生素;对照组642例术前未应用抗生素,对比两组术后早期感染发生率情况。结果 842例中共10例发生手术部位感染,其中治疗组2例(1%),对照组8例(1.2%),两组比较差异无统计学意义。比较两组术后第3天血白细胞计数、中性粒细胞比值、住院时间差异亦无统计学意义。结论无高危因素的成人腹股沟疝无张力修补术常规应用抗生素对预防术后手术部位感染并无实质必要。     

Platelet‐rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections

Despite the large choice of wide‐spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life‐threatening complication worldwide. This study evaluated that the use of platelet‐rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery.     

急性非复杂性阑尾炎的治疗选择——病例对照分析

【摘要】 目的〓分析比较单纯抗生素治疗及阑尾切除术在治疗急性非复杂性阑尾炎(AUA)中的疗效及安全性。方法〓符合入组及排除标准的患者分为2组:抗生素组(108例)及手术组(111例)。抗生素组中的患者接受头孢类联合甲硝唑的抗菌方案,手术组中的患者接受阑尾切除术及围手术期抗菌治疗。研究的首要研究指标是治疗疗效,继而分析两组患者间其他临床疗效因素的异同。结果〓手术组的所有患者中手术顺利,治疗成功率为100.0%。抗生素组中治疗成功率为77.8%(84/108)。意向分析研究结果发现两组患者间疗效相差22.2%,在24%的非劣性研究范围内,认为抗生素治疗效果并不劣于手术治疗。研究发现抗生素组的患者在并发症、住院费用、住院期间疼痛VAS评分方面明显优于手术组。结论〓接受抗生素治疗的AUA患者的疗效与阑尾切除的相近,而且接受抗生素治疗的AUA患者疼痛少、恢复快、花费少,结合较低的急性阑尾炎复发率显示抗生素治疗AUA是可行的方法。     

Anterior screw fixation in type II odontoid fractures: is there a difference in outcome between age groups?

OBJECTIVE: Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. METHODS: We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls. RESULTS: There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied. CONCLUSION: Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.     

Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery

Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.     

Antibiotic prophylaxis in oesophageal surgery.

A prospective randomised study to assess the efficacy of antibiotic prophylaxis in oesophageal surgery was performed, in which 226 consecutive patients (113 male and 113 female, age range 24-86 years, mean age of 65 years) were included. The study patients were in two groups: group 1, in which the upper alimentary tract was opened during surgery, and group 2, in which it was not. The group 1 patients (n = 129) were randomised to one of three antibiotic prophylaxis regimes prior to surgery. Group A patients (n = 42) were treated with cefuroxime (CFX) 1.5 g at induction of anaesthesia and then CFX 750 mg b.i.d. for 4 days. Group B patients (n = 46) were treated with CFX 1.5 g and metronidazole (MTR) 1.0 g at induction of anaesthesia, then CFX 750 mg b.i.d. and MTR 500 mg qds for 4 days. Group C (n = 41) treated with CFX 1.5 g and MTR 1.0 g at the induction of anaesthesia. Group 2 (n = 97) was divided into two groups, group D (n = 47) treated with CFX 1.5 g on induction of anaesthesia alone. Group E (n = 50) treated with CFX 1.5 g on induction of anaesthesia then CFX 750 mg bd for 2 days. We found a significantly higher incidence of infective complications in subgroup C (43.9%) and subgroup A (21.4%) compared to subgroup B (8.6%). This difference was most marked in patients undergoing oesophagectomy. We found significantly higher infection rates of infective complications in subgroup D (10.6%) as compared to subgroup E (2%).     

The necessity of prophylactic antibiotics in uncomplicated appendicitis during childhood.

A prospective, randomized, clinical study was done to evaluate the place of prophylactic antibiotics in uncomplicated childhood appendicitis. One hundred patients with uncomplicated appendicitis were randomly assigned to one of four groups, each consisting of 25 cases. Group 1 patients did not receive prophylactic antibiotic. Group 2, group 3, and group 4 patients received ornidazole, penicillin plus tobramycin, and piperacillin, respectively. The use of prophylactic antibiotics did not yield better results than the use of placebos. The rarity of infectious complications after uncomplicated appendicectomy may be unique for children. Although the need for antibiotic prophylaxis is well documented in adults, the rarity of infectious complications makes it highly questionable in the treatment of uncomplicated appendicitis in children.     

低剂量丝裂霉素C术中肿瘤基底部注射加即刻灌注预防膀胱肿瘤复发

目的探讨低剂量丝裂霉素C（MMC）术中肿瘤基底部注射加即刻膀胱灌注对预防术后复发和进展的有效性及可行性。方法51例膀胱移行细胞癌初发病例，均接受保留膀胱手术；术中随机分成两组：A组（治疗组）27例，采用低剂量MMC（0．1g／L）术中肿瘤基底部注射，联合膀胱即刻灌注；B组（对照组）24例仅术后采取MMC（0．4g／L）定期膀胱内灌注治疗。术后随访12—60个月，比较两组复发率（RR）及进展率（PR），并分析其与初发肿瘤分期、分级的关系。结果A组复发3例，平均复发时间15．67个月，RR11．11％（3／27），B组复发9例，平均复发时间11个月，RR为37．50％（9／24），两组间复发率比较差异有显著性（P〈0．05）；两组复发肿瘤细胞病理分级升高共4例，其中A组病理由Gz升高至G2 1例；B组G1升高至G2 1例，由G2升高至G3 2例，相互比较差异无统计学意义（P〉0．05）；两组中共有9例发生肌层浸润进展，其中B组3例，浸润至膀胱浅肌层的T2期；A组1例，B组5例，浸润至深肌层的T3期，两组间分期PR比较差异有显著性（P〈0．05）；治疗期间，共有26例发生局部反应，未见膀胱黏膜坏死、骨髓抑制等严重并发症。结论低剂量MMC（0．10g／L）术中肿瘤基底部注射联合即刻膀胱灌注，对预防膀胱肿瘤术后复发及抑制肿瘤分期进展疗效均明显优于单纯MMC术后定期膀胱灌注治疗，且安全、可靠，尤其适用于低中风险的Ta或T1期的膀胱肿瘤患者，为T2或T3期的膀胱肿瘤患者增加了保留膀胱的治疗机会，可作为治疗膀胱肿瘤的较为理想的方法。     

局部应用水蛭素对扩张皮瓣静脉淤血的防治

目的 探讨局部应用水蛭素对扩张皮瓣静脉淤血的防治作用。方法 以白色小型家猪为实验对象,将其模拟成扩张皮肤转移术后的淤血皮瓣,随机分成三组,A组（局部注射天然水蛭素,0.5 U/皮瓣）、B组（局部注射天然水蛭素,1 U/皮瓣）和对照组。进行大体观察、病理切片和ET-1、NO、TXB2的测定。结果 用药组（A组与B组间差异无显著意义）术后与对照组比较淤血消散快。光镜下用药组与对照组微血管淤血同期比较有明显差异。用药组的ET-1、NO、TXB2与对照组同期比较差异有显著意义（P＜0.05）。结论 水蛭素的局部应用对扩张皮瓣静脉淤血有明显的防治作用。     

The "Mannit-Ceftriaxon" preparation for elective colorectal surgery.

Authors report their experiences with evaluating the clinical course of 45 patients undergoing elective colorectal surgery. Patients were divided into three groups, depending on the type and method of preparation to operation. The 140 patients in the first group received according to the "traditional" preparation purgatives, enemas, and mycerine + metronidazole prophylaxis. The preparation of the 160 patients involved in the second group was performed by giving mannit solution (10%) orally 12 hours prior to surgery, and a single dose of 2 g ceftriaxon (Rocephin, Hoffman-La Roche) intravenously 2 hours preoperatively. The preparation for the 150 patients enrolled into the third group was done also by giving mannit solution orally, and for antibiotic prophylaxis 2 g ceftriaxon was given intravenously as in the second group, but an additional 500 mg metronidazole was also given at the same time as the ceftriaxon intravenously. The evaluation of the cases proves, that the mannit + ceftriaxon method warrants satisfactory protection for colorectal surgery, and the necessary time interval is only 12 hours. The rate of septic complications and septic death was higher in the first, traditionally pretreated group, than in the other two. The CTX + metronidazole combination used in the third group was not superior to the administration of ceftriaxon alone.     

Follow-up of long-term treatment with clean intermittent catheterization for neurogenic bladder in children

OBJECTIVES: To assess the results of long-term clean intermittent catheterization (CIC) treatment for neurogenic bladder in children born with myelomeningocele, and to compare the long-term results between the early treatment group (< 1 year old) and late treatment group (> 3 years old). METHODS: Thirty-six paediatric patients with myelomeningocele who were treated in the first year of life (Group 1) and 31 cases who were treated after the age of 3 years (Group 2) were followed regularly for at least 11 years. All medical records were reviewed and long-term results of treatment, including increases in blood urea nitrogen (BUN) and serum creatinine, development of hydronephrosis, recurrent upper urinary tract infection, and the number of augmentation cystoplasties needed, were noted. Kaplan-Meier methods were used to analyse time-to-event data. RESULTS: Mean age at start of treatment was 6.88 months (range, 3-1 months) in Group 1 and 44.97 months (range, 37-60 months) in Group 2. Increases in BUN and serum creatinine were found in 12 cases (33.3%) in Group 1 and 19 cases (61.3%) in Group 2. Patients in Group 2 showed earlier renal deterioration and worse renal function at the last follow-up. Hydronephrosis was found in 10 cases (27.8%) in Group 1 and 18 cases (58.1%) in Group 2. Patients in Group 2 also had earlier and more severe hydronephrosis. Augmentation cystoplasty was needed in five cases (13.9%) in Group 1 and 10 cases (32.3%) in Group 2.The results of surgery were better in Group 1 than in Group 2, and surgery was needed earlier in Group 2 compared with Group 1. There was no significant difference regarding upper urinary tract infection between the two groups. CONCLUSIONS: For most patients and with close long-term follow-up, early treatment of neurogenic bladder using CIC in children born with myelomeningocele yields better results than late treatment. In our experience, treatment is recommended as soon as possible, especially during the first year of life.