摘要
目的探讨胃癌腹腔镜微创手术术后切口感染病原学特点及细胞炎性因子和胃肠激素变化情况。方法选择2011年1月-2017年1月医院收治的行腹腔镜微创手术胃癌患者314例为研究对象。根据术后切口医院感染发生情况分为感染组与未感染组,采集感染患者切口分泌物标本进行病原菌的分离与鉴定。采用酶联免疫吸附法测定患者血清CRP、TNF-α和PCT含量,采用放射免疫法测定胃泌素和胃动素含量。结果 314例胃癌行腹腔镜微创手术患者,术后发生切口感染31例,感染率为9.87%。共分离培养病原菌45株,其中革兰阴性菌24株、革兰阳性菌18株、真菌3株。革兰阴性菌中,主要为大肠埃希菌和铜绿假单胞菌,分别占17.78%和15.56%;革兰阳性菌中,主要为金黄色葡萄球菌占13.33%。两组患者术前12h血清CRP、TNF-α、PCT、血清胃泌素和胃动素水平比较差异无统计学意义,两组术后24h指标水平均较术前增加,差异有统计学意义(P<0.05);且感染组高于未感染组(P<0.05)。结论胃癌腹腔镜微创手术术后切口感染率较高,病原菌以革兰阴性菌为主,术后切口感染患者炎症因子水平升高且影响患者胃肠功能,因此对感染者需采取积极有效的预防手段,旨在减轻炎性反应和促进胃肠功能恢复。
OBJECTIVE To explore the etiological characteristics of postoperative incision infection in gastric cancer patients undergoing laparoscopic minimally invasive surgery and analyze the changes of inflammatory cytokines and gastrointestinal hormones.METHODS A total of 314 gastric cancer patients who underwent laparoscopic minimally invasive surgery from Jan 2011 to Jan 2017 were recruited as the study objects and vided into the infection group and the non-infection group according to the incidence of postoperative incision infection.The incision secretions specimens were collected from the patients with infection,the pathogens were isolated and identified.The levels of serum CRP,TNF-α and PCT of the patients were determined by using enzyme-linked immunosorbent assay,and the levels of gastrin and motilin were determined with the use of radioimmunoassay.RESULTS Of the 314 gastric cancer patients who underwent the laparoscopic minimally invasive surgery,31 had postoperative incision infection,with the infection rate 9.87%.Totally 45 strains of pathogens were isolated,24 of which were gram-negative bacteria,18 were gram-positive bacteria,and 3 were fungi.Escherichia coli and Pseudomonas aeruginosa were the predominant species of the gram-negative bacteria,accounting for 17.78% and 15.56%,respectively;Staphylococcus aureus was dominant among the gram-positive bacteria,accounting for 13.33%.There were no significant differences in the levels of serum CRP,TNF-α,PCT,serum gastrin and motilin between the two groups of patients 12 hours before the surgery;the levels of the above indexes of the two groups of patients were significantly higher after the surgery for 24 hours than before the surgery(P<0.05);the levels of the above indexes of the infection group were significantly higher than those of the non-infection group(P<0.05).CONCLUSION The incidence of postoperative incision infection is high in the gastric cancer patients undergoing the laparoscopic minimally invasive surgery,the gram-negative bacteria are dominant among the pathogens,the levels of the inflammatory cytokines of the patients with postoperative incision infection are elevated,which may influence the gastrointestinal function,therefore,it is necessary to take effective prevention measures for the patients with infection so as to alleviate the inflammatory reactions and facilitate the recovery of gastrointestinal function.
作者
傅金龙
王先法
汪勇
胡可
黄坚
洪强
FU Jin-long;WANG Xian-fa;WANG Yong;HU Ke;HUANG Jian;HONG Qiang(Sir Run Run Shaw Hospital School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第1期91-94,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生一般研究计划(2014KYB121)
关键词
胃癌腹腔镜微创手术
术后切口感染
病原菌
细胞炎性因子
胃肠激素
Laparoscopic minimally invasive surgery for gastric cancer
Postoperative incision infection
Pathogen
Inflammatory cytokine
Gastrointestinal hormone
