肝内胆管结石手术切口感染危险因素分析

目的：分析肝内胆管结石术后切口感染的危险因素，为降低术后切口感染发生率提供有效预防措施。 方法：回顾性分析2005年7月—2012年12月间手术117例治疗肝内胆管结石患者临床资料，根据患者是否接受预防切口感染的特殊围手术期处理分为特殊处理组与常规处理组，比较两组患者术后切口感染发生率及其他临床指标；再根据患者是否发生切口感染将患者分为感染组与非感染组，分析引起切口感染的危险因素。 结果：与常规处理组比较，特殊处理组术后切口感染发生率明显降低（14.6% vs. 36.8%），引流管拔除时间、抗生素使用时间、术后住院时间明显缩短、住院费用明显减少（均P<0.05）。单因素分析显示，术后切口感染与年龄、合并糖尿病、术前胆管炎、既往胆道手术史、胆汁培养阳性、术中采取预防措施、手术时间、拔除引流管时间有关（均P<0.05）；多因素分析显示，合并糖尿病、既往胆道手术史和延迟拔除引流管是术后切口感染的危险因素，而术中采取预防措施是保护性因素（均P<0.05）。 结论：合并糖尿病、既往胆道手术史和术后延迟拔除引流管是术后切口感染的独立危险因素，而术中采取预防措施可降低肝内胆管结石患者术后切口感染发生率，且有利于患者快速康复。

Risk factor analysis for surgical site infection after surgical treatment of hepatolithiasis

Objective: To analyze the risk factors for surgical site infection after surgical treatment of hepatolithiasis, and provide effective preventive measures to reduce this problem. Methods: The clinical data of 117 hepatolithiasis patients undergoing surgical treatment from July 2005 to December 2012 were retrospectively analyzed. The patients were firstly divided, according to whether they received the special perioperative management for prevention of postoperative surgical site infection, into special treatment group and conventional treatment group, and the incidence of postoperative surgical site infection along with other clinical parameters were compared between the two groups; next, the patients were divided, according to whether they had surgical site infection, into infection group and non-infection group, and the risk factors for postoperative surgical site infection were analyzed. Results: Compared with conventional treatment group, the incidence of postoperative surgical site infection was significantly decreased (14.6% vs. 36.8%), time to drainage tube removal and length of time of antibiotic administration and postoperative stay were significantly shortened, and hospitalization cost was significantly reduced in special treatment group (all P<0.05). The univariate analysis showed that postoperative surgical site infection was associated with age, concomitant diabetes, preoperative cholangitis, previous history of biliary surgery, positive bile culture, intraoperative preventive measures, operative time and drainage tube retention time (all P<0.05); further multivariate analysis identified that concomitant diabetes, previous history of biliary surgery and long drainage tube retention time were risk factors, while implementation of intraoperative preventative measures was protective factor for postoperative surgical site infection. Conclusion: Concomitant diabetes, previous history of biliary surgery and long drainage tube retention time are independent risk factors for postoperative surgical site infection, while implementation of intraoperative preventive measures can reduce incidence of surgical site infection and is beneficial to fast recovery of the patients.