克罗恩病患者肠切除术后吻合口感染性并发症的危险因素分析

摘要

目的 探讨影响克罗恩病(CD)患者肠切除术后吻合口感染性并发症发生的危险因素.方法 回顾性分析1990年1月至2012年10月间在浙江省丽水市人民医院接受肠切除手术的114例CD患者的临床资料,分别通过x2检验和Logistic回归模型对术后发生吻合口感染性并发症的发生风险进行单因素和多因素分析.结果 术后吻合口感染性并发症发生率为12.3％(14/114),其中吻合口瘘7例,腹腔脓肿6例,肠外瘘1例.多因素分析显示,克罗恩病活动指数(CDAI)大于150(OR=2.185,95％CI:1.098～6.256)、术前使用甾体类药物(OR=2.674,95％CI:1.118～8.786)及合并腹腔脓肿和(或)瘘(OR=3.447,95％CI:1.254～10.462)是术后出现吻合口感染性并发症的独立高危因素(均P＜0.05).无上述危险因素者术后吻合口感染性并发症发生率为5.7％(3/53),有1个危险因素者为11.4％(4/35),2个危险因素者21.1％(4/19),3个危险因素者则可高达42.9％(3/7).结论 术前使用甾体类药物、CDAI大于150及合并腹腔脓肿和(或)瘘是CD肠切除术后出现吻合口感染性并发症的高危因素.如果这些危险因素术前无法消除,肠切除术后行一期吻合应持谨慎态度.%Objective To investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.Methods Clinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively.The risk factors were identified by x2 test and Logistic regression.Results Fourteen patients (12.3％,14/114) developed anastomotic infectious complications in the postoperative period,including anastomotic leak (n=7),intra-abdominal abscess(n=6),and enterocutaneous fistula (n=1).Crohn disease activity index (CDAI)＞150 (OR=2.185,95％CI:1.098-6.256,P=0.040),steroid usage (OR=2.674,95％CI:1.118-8.786,P=0.027),and the presence of preoperative abscess/fistula (OR=3.447,95％ CI:1.254-10.462,P=0.014) were identified as independent risk factors of anastomotic infectious complications.In the absence of these 3 risk factors,the rate of anastomotic infectious complication was 5.7％ (3/53),which increased to 11.4％ (4/35) when one risk factor was present,21.1％(4/19) when two risk factors were present,and 42.9％(3/7) when all the 3 risk factors were present.Conclusions CDAI＞150,steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease.A prudent management should be carried out if risk factors can not be eliminated preoperatively.