Perioperative infection control and its effectiveness in hepatectomy patients
Perioperative infection control and its effectiveness in hepatectomy patients
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DOI：
10.1111/j.1440-1746.2006.04761.x
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发表时间：
2007-11-01
影响因子：
4.1
通讯作者：
Shimada, Hiroshi
中科院分区：
文献类型：
--
作者：
Togo, Shinji;Matsuo, Kenichi;Shimada, Hiroshi
背景和目的：肝切除术后感染需要特别注意，因为它们可能恶化为肝功能衰竭。我们回顾性分析了这种感染的情况下，没有胆道或肠道reconstructs.Methods：这项回顾性研究涉及535例肝肿瘤谁在横滨市立大学医院消化外科1992年4月至2005年3月进行肝切除术。根据不同时期感染对策的变化分为四组后，检查治疗结果。第一阶段未采取抗感染措施，第一、第二阶段采用封闭式吸引引流系统和术后早期肠内营养，第二、第三阶段增加了彻底处理胆漏和预防医院感染的措施;在第三和第四阶段之间，使用可吸收缝线代替丝线进行手术部位感染（SSI）监测。术后感染的发生率显著降低，采取了额外的对策：第一阶段44.7%;第二阶段24.1%;第三阶段15.0%;第四阶段9.2%。SSI和远端感染的发生率也同样降低。术后感染的危险因素为年龄、糖尿病、使用丝线和胆漏，而SSI的危险因素为使用丝线和胆漏。结论：通过我们的感染对策，尤其是胆漏管理和使用可吸收缝线，术后感染和SSI的发生率显著降低。
Background and Aim: Post-hepatectomy infections require careful attention, because they may deteriorate into liver failure. We retrospectively reviewed such infections in cases without biliary or intestinal reconstruction.Methods: This retrospective study involved 535 patients with liver tumors who underwent hepatectomy at the Department of Gastroenterological Surgery of Yokohama City University Hospital between April 1992 and March 2005. After classification into four groups depending on changes in infection countermeasures used during different periods, the treatment outcomes were examined. No such anti-infection measures were taken during the first period; a closed suction drainage system and early enteral nutrition after surgery were introduced between the first and second periods; thorough management of bile leakage and prevention of nosocomial infection were added between the second and third periods; and surgical site infection (SSI) surveillance together with absorbable sutures instead of silk sutures between the third and fourth periods.Results: The incidence of postoperative infection decreased significantly with additional countermeasures: first period 44.7%; second period 24.1%; third period 15.0%; and fourth period 9.2%. The incidence of both SSI and remote infection were similarly reduced. Postoperative infection risk factors were age, presence of diabetes mellitus, the use of silk sutures and bile leakage, while those for SSI were the use of silk sutures and bile leakage.Conclusion: The incidence of postoperative infection and SSI were significantly reduced by our infection countermeasures, especially by bile leakage management and the use of absorbable sutures.