| 袁锡裕,李庆贤,龚时文,曹建明,陈剑辉.结直肠癌术后并发腹腔感染患者的病原学特点、危险因素分析及对患者预后的影响[J].,2019,19(20):3929-3934 |
| 结直肠癌术后并发腹腔感染患者的病原学特点、危险因素分析及对患者预后的影响 |
| Pathogenic Characteristics, Risk Factors and Prognosis of Patients with Abdominal Infection after Colorectal Cancer Surgery |
| 投稿时间：2019-04-30 修订日期：2019-05-24 |
| DOI：10.13241/j.cnki.pmb.2019.20.029 |
| 中文关键词: 结直肠癌 腹腔感染 病原学 危险因素 耐药性 预后 |
| 英文关键词: Colorectal cancer Abdominal infection Etiology Risk factors Drug resistance Prognosis |
| 基金项目:广东省自然科学基金项目（2014A030310111） |
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| 中文摘要: |
| 摘要 目的：分析结直肠癌患者术后并发腹腔感染的常见病原菌及其耐药性，探讨其危险因素及对患者预后的影响。方法：回顾性纳入2012年1月至2015年1月于我院行结直肠癌根治手术治疗的225例患者为研究对象，根据术后是否出现腹腔感染，将患者分为感染组（31例）和未感染组（194例），疑似感染患者进行病原菌培养鉴定以及药敏试验，分析影响结直肠癌根治术后腹腔感染的危险因素，对比两组病死率、无进展生存期（PFS）以及复发率。结果：结直肠癌根治术后腹腔感染发生率为13.77%，共检出菌株67株，革兰阴性菌检出率最高，其次是革兰阳性菌、真菌。大肠埃希菌对亚胺培南敏感，耐药率为0.00%。克雷伯菌对亚胺培南、阿米卡星、妥布霉素敏感，耐药率均为0.00%。铜绿假单胞菌对妥布霉素较为敏感，耐药率为11.11%。表皮葡萄球菌对左氧氟沙星、妥布霉素、环丙沙星、亚胺培南较为敏感，耐药率分别为0.00%、0.00%、12.50%、12.50%。单因素分析显示：结直肠癌根治术后并发腹腔感染与术前血红蛋白水平、术前血清白蛋白水平、是否合并糖尿病、TNM分期、Dukes分期、手术类型、手术时间、术中出血量、是否联合脏器切除、是否术后造口、有无吻合口瘘、术后引流管留置时间有关（P＜0.05）。多因素Logistic回归分析显示：合并糖尿病、联合脏器切除、术前血清白蛋白水平＜35 g/L、手术时间≥160 min 、术后造口、吻合口瘘、术后引流管留置时间≥11d是结直肠癌根治术后并发腹腔感染的独立危险因素（P＜0.05）。与未感染组相比，感染组3年病死率、复发率升高，PFS显著缩短（P＜0.05）。结论：结直肠癌根治术后并发腹腔感染受多种因素影响，感染率较高，预后较差。感染病原菌以革兰阴性菌为主，并对抗生素有一定耐药性。临床应对合并糖尿病、术前血清白蛋白水平过低、术中联合脏器切除、手术时间过长、术后造口、吻合口瘘、术后引流管留置时间过长患者做好预防术后感染工作，亚胺培南、妥布霉素可用于防治结直肠癌根治术后耐药菌引起的腹腔感染。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the common pathogenic bacteria and drug resistance of patients with abdominal infection after colorectal cancer surgery, and to explore the risk factors and the effect on the prognosis of patients. Methods: A retrospective study was conducted on 225 patients who underwent radical operation for colorectal cancer from January 2012 to January 2015. According to the occurrence of abdominal infection after operation, the patients were divided into infection group (31 cases) and uninfected group (194 cases). The suspected infected patients were identified by pathogen culture and drug sensitivity test, and the risk factors of abdominal infection after radical operation for colorectal cancer were analyzed. The mortality, progression-free survival (PFS) and recurrence rates were compared between the two groups. Results: The incidence of abdominal infection with patients after colorectal cancer surgery was 13.77%. A total of 67 strains of strains detected, gram negative bacteria had the highest detection rate, followed by gram-positive bacteria and fungi. Escherichia coli was sensitive to imipenem and the drug resistance rate was 0%. Klebsiella pneumoniae was sensitive to imipenem, Amikacin and tobramycin, and the drug resistance rates were 0%. Pseudomonas aeruginosa was sensitive to tobramycin, and the drug resistance rate was 11.11%. Staphylococcus epidermidis was more sensitive to levofloxacin, tobramycin, ciprofloxacin and imipenem, and the drug resistance rates were 0%, 0%, 12.50% and 12.50% respectively. Single factor analysis showed that abdominal infection after colorectal cancer surgery was related to preoperative hemoglobin level, preoperative serum albumin level, diabetes mellitus, TNM stage, Dukes stage, operation type, operation time, intraoperative bleeding, viscera resection, postoperative stoma, anastomotic fistula and postoperative drainage tube retention time (P<0.05). Multiple Logistic regression analysis showed that combined diabetes mellitus, combined visceral resection, preoperative serum albumin level<35 g/L, operation time>160 min, postoperative stoma, anastomotic fistula and postoperative drainage tube retention time≥11d were the independent risk factors of abdominal infection after colorectal cancer surgery(P<0.05). Compared with the uninfected group, the 3-year mortality and recurrence rate of the infected group was higher, and PFS was significantly shortened(P<0.05). Conclusion: Abdominal infection after colorectal cancer surgery is affected by many factors, with high infection rate and poor prognosis. The infection pathogenic bacteria are mainly gram-negative bacteria, and the antibiotics have certain resistance. Preventive measures should be taken for patients with diabetes mellitus, low preoperative serum albumin level,intraoperative combined visceral resection, long operation time, postoperative stoma, anastomotic fistula and long postoperative drainage tube retention time to prevent post-operative infection, and imipenem and tobramycin can be used to prevent and treat peritoneal infection caused by drug-resistant bacteria after radical resection of colorectal cancer. |
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