胆道术后(不包括胆囊切除术)并发感染的危险因素分析及预防措施

摘要

Objective To explore the related-risk factors for postoperative infections in the patients with biliary diseases(not including cholecystectomy)and the prevention measures,in order to prevent the occurrence of postoperative infection and reduce the incidence of it.Methods We retrospectively collected the data from 241 patients who suffered from biliary system diseases and then got treated in our hospital from April to May 2015,analyzed the risk factors of the postoperative infection and put forward the prevention methods.We use the SAS9.1.3 software to perform the statistical analysis of data.Results Of all those 241 patients accepted surgical treatments in our hospital(not including cholecystectomy),25 infection case were found with an infection rate of 10.37％;The infection occurred from the 1 st day to the 14th day postoperatively,and the median time of the occurrence is on the 7th day.The enterocoelia,biliary tract,blood,surfical incision and lung were the major infection sites,accounting for 40％,32％,12％,8％ and 8％,respectively.The single factor analysis shows:The incidence of the postoperative infection was influenced by blood transfusion,bilioenteric anastomosis,the level of preoperative total bilirubin(＞ 34μmoL/L),the preoperative white blood cells condition(＞ 10 × 109/ L),the duration of postoperative drainage(≥6 d),and other postoperative complications happened before infection.Positive analytical results were found with a statistically significant difference of P ＜ 0.05.Multiple-factor analysis shows:the preoperative white blood cells condition(＞ 10 × 109/L) and the duration of postoperative drainage(≥6 d) are independent risk factors for postoperative infection.Conclusions The inflammation of bile duct and the postoperative drainage are closely associated with the incidence of the postoperative infection in the patients with biliary system diseases.Undergoing the surgery after the bile duct inflammation subside and keeping postoperative drainage unobstructed are significant to prevent the occurrence of postoperative infection.%目的 探讨胆道手术(不包括胆囊切除术)后并发感染的危险因素及预防措施,以预防术后感染的发生及降低胆道手术后感染的发生率.方法 对2015年4月和5月两个月我院收治并行胆道手术(不包括胆囊切除术)的241例胆道系统疾病患者的临床资料进行回顾性分析,并总结与术后感染发病相关的危险因素及预防措施.采用SAS9.1.3软件对数据进行统计分析.结果 241例胆道手术,发生感染25例,感染率为10.37％;感染均发生于术后第1～ 14天,中位时间是7天;感染部位为:腹腔、胆道、血液、切口和肺部,分别占40％、32％、12％、8％和8％;单因素分析结果提示:输血,胆肠吻合术,术前白细胞(＞ 10×109/L),术前总胆红素(＞34μmol/L),引流管时间(≥6天)和术后并发症是导致胆道手术后感染的危险因素,差异有统计学意义(P＜0.05);多因素分析结果显示:术前白细胞(＞ 10×109/L)和引流管时间(≥6天)是导致胆道术后感染的独立危险因素,差异有统计学意义(P＜0.05).结论 胆道系统疾病术后感染的发生和胆管炎症、术后引流关系密切.待胆道炎症消退进行手术,保持术后引流通畅,对预防胆道术后感染具有重要意义.