摘要
目的通过探讨胰十二指肠切除术(PD)后发生复杂腹腔感染(cIAI)的相关影响因素及病原菌构成,为PD后cIAI的预防提供一定的依据。方法回顾性分析2010年1月至2020年1月于宁夏医科大学总医院行PD患者病例资料,按照纳入标准收集发生cIAI 89例为感染组;从360余例未发生cIAI患者中按照约1∶1的比例等距随机抽样91例为对照组。收集感染组术后引流液的细菌培养情况,统计描述病原菌构成;单因素和多因素Logistic回归分析PD后发生cIAI的危险因素。结果术前减黄(OR=6.569,95%CI:1.178~14.630)、手术时间≥6 h(OR=6.872,95%CI:2.258~20.913)和术后胰瘘(OR=3.426,95%CI:1.219~9.631)是PD后发生cIAI的危险因素(均P<0.05)。培养菌株28种,革兰阴性菌以大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌居多(总构成比为50.00%),革兰阳性菌以屎肠球菌居多(构成比为52.17%),真菌中以白色念珠菌居多(构成比为92.86%)。结论PD后发生cIAI病情危重,合理的术前减黄及缩短手术时间对于cIAI的预防尤为重要,应及时合理应用抗生素进行综合治疗。
Objective To explore the related factors and pathogen composition of complicated intra-abdominal infection(cIAI)after pancreaticoduodenectomy(PD),providing evidence for the prevention of cIAI after PD.Methods From January 2010 to January 2020,89 patients with cIAI after PD were retrospectively collected as the infectious group in General Hospital of Ningxia Medical University.According to the inclusion criteria,91 patients without cIAI after PD were collected as the control group by equidistant random sampling at a ratio of about 1∶1.The pathogen composition was described statistically according to the results of bacterial culture of the drainage fluid in the infection group.The risk factors of cIAI after PD were analyzed by single-and multi-variate Logistic regression analysis.Preoperative biliary drainage(OR=6.569,95%CI:1.178-14.630),operation time≥6 h(OR=6.872,95%CI:2.258-20.913)and pancreatic fistula(OR=3.426,95%CI:1.219-9.631)were the risk factors for cIAI after PD(all P<0.05).There were 28 varieties of cultivated strains.The majority of gram-negative bacteria were Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae,the total composition ratio was 50.00%.Enterococcus faecium was the major Gram-positive bacteria,with a composition ratio of 52.17%;and Candida albicans is the most common fungus(92.86%).Conclusions The occurrence of cIAI after PD is critical.Rational preoperative biliary drainage and shortening surgery time are particularly vital for the prevention of cIAI.Comprehensive treatment with antibiotics should be carried out in a timely and reasonable manner.
作者
李存权
崔磊
柳科军
李政权
刘俊豪
卜阳
Li Cunquan;Cui Lei;Liu Kejun;Li Zhengquan;Liu Junhao;Bu Yang(Department of Hepatobiliary Surgery,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical Universtiy,Yinchuan 750004,China)
出处
《中华普通外科学文献（电子版）》
CAS
2022年第6期417-421,共5页
Chinese Archives of General Surgery(Electronic Edition)
关键词
胰十二指肠切除术
复杂腹腔感染
危险因素
病原菌
Pancreaticoduodenectomy
Complicated intra-abdominal infection
Risk factors
Pathogens
