腹腔镜阑尾切除术后腹腔脓肿的危险因素研究

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)后发生腹腔脓肿的危险因素,为制定预防治疗措施提供依据。方法:回顾研究2013年1月至2015年6月561例行LA患者的临床资料,按性别、阑尾病理分型、有无糖尿病、是否腹腔冲洗及腹腔引流分组,比较术后腹腔脓肿的发生率。对发生腹腔脓肿者采用单因素分析及多因素分析进一步明确术后腹腔脓肿的危险因素。结果:561例患者中508例纳入本研究,其中14例(2.76%)术后发生腹腔脓肿,腹腔冲洗组术后脓肿发生率显著高于未冲洗组(9.02%vs.0.53%,P=0.001)。单因素分析结果显示,术后腹腔脓肿的危险因素包括年龄(P=0.001)、手术时间(P=0.031)、术后抗生素使用时间(P=0.000)、术中腹腔冲洗等。多因素分析结果显示,术中腹腔冲洗是引起LA术后腹腔脓肿的唯一危险因素(P=0.001),发生腹腔脓肿者术后抗生素使用时间显著延长。结论:术中腹腔冲洗是LA术后发生腹腔脓肿的独立危险因素,避免不必要的术中腹腔冲洗有助于预防LA术后腹腔脓肿的形成。

Risk factors for postoperative intra-abdominal abscess after laparoscopic appendectomy

Objective:To identify the risk factors for intra-abdominal abscess (IAA) after laparoscopic appendectomy,and provide reference for developing infection control strategies.Methods:Clinical data of 561 patients who received laparoscopic appendectomy between Jan.2013 and Jun.2015 were reviewed and analyzed.Perioperative data including patient gender,histologic grade of appendix,diabetes,peritoneal irrigation and drainage were collected from patients files.The incidence of postoperative IAA was compared.IAA group and non-IAA group were compared with univariate and multivariate analyses for the risk factors.Results:Five hundred and eight of 561 patients were enrolled,14 of them (2.76%) developed postoperative IAA.The incidence of IAA was significantly higher in peritoneal irrigation group than non-irrigation group (9.02% vs 0.53%,P=0.001).Univariate analysis showed that the risk factors for IAA were patient's age (P=0.001),duration of surgery (P=0.031),peritoneal irrigation (P=0.001) and period of antibiotic therapy (P=0.000).Multivariate logistic regression analysis showed that peritoneal irrigation was the only risk factor for the development of IAA (P=0.001).Patients who suffered from postoperative IAA used antibiotics for longer period.Conclusions:Peritoneal irrigation is shown to be the only risk factor for the development of postoperative IAA after laparoscopic appendectomy.Unnecessary irrigation should be avoided to prevent postoperative IAA.