Risk factors for postoperative infectious complications after hepatectomy
Risk factors for postoperative infectious complications after hepatectomy
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DOI：
10.1007/s00534-010-0313-1
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发表时间：
2011-01-01
影响因子：
3
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
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作者：
Uchiyama, Kazuhisa;Ueno, Masaki;Yamaue, Hiroki
本研究旨在阐明肝切除术后手术部位感染（ssi）的发生率。回顾性分析338例选择性手术治疗肝结石、肝细胞癌和转移癌患者的数据库记录，以确定术后感染并发症的发生情况。评估肝切除术后30天内，表浅或深切口ssi和脏器或间隙ssi的发生率及所有其他感染性并发症。肝结石肝切除术后ssi的发生率（23.8%）高于HCC肝切除术后的发生率（11.3%）（p = 0.034）和转移性癌肝切除术后的发生率（2.7%）（p < 0.001）， HCC肝切除术后ssi的发生率高于转移性癌肝切除术后的发生率（p = 0.028）。然而，三组之间的远程部位感染发生率无显著差异。肝内胆管结石肝切除术后浅切口或深切口ssi的发生率（11.9%）高于转移性癌肝切除术后的发生率（1.4%）（p < 0.001）， HCC肝切除术后浅切口或深切口ssi的发生率（7.8%）高于转移性癌肝切除术后的发生率（1.4%）（p = 0.050）。肝内胆管结石患者（11.9%）与HCC患者（3.6%）、肝内胆管结石患者（1.4%）与转移性癌患者（p < 0.001）的间隙/脏器ssi发生率差异有统计学意义（p = 0.029）。本研究中所有患者的胆汁培养阳性率为36.2%，肝内胆管结石、肝细胞癌和转移癌患者的阳性率分别为83.3%、7.8和10.0%。肝内胆管结石患者的胆汁培养阳性率明显高于肝癌或转移癌患者（p < 0.001）。我们的研究表明术后ssi与胆汁感染之间存在关系，从而支持肝切除术后感染与肝功能、血糖控制和营养状况等变量之间的关系。
This study aimed to clarify the incidence of surgical site infections (SSIs) after hepatectomy.The database records of three hundred and eight patients who underwent elective surgical treatment for hepatolithiasis, hepatocellular carcinoma (HCC), and metastatic carcinoma were retrospectively analyzed to determine the occurrence of postoperative infectious complications. The incidences of SSIs, classified as superficial or deep incisional SSIs and organ or space SSIs, and all other infectious complications within 30 days after hepatectomy were evaluated.The incidences of SSIs after a hepatectomy for hepatolithiasis (23.8%) were higher than those after a hepatectomy for HCC (11.3%) (p = 0.034) and after a hepatectomy for metastatic carcinoma (2.7%) (p < 0.001), and the incidence of SSIs after a hepatectomy for HCC was higher than that after a hepatectomy for metastatic carcinoma (p = 0.028). However, there was no significant difference in the incidence of remote site infections between the three groups. The incidence of superficial or deep incisional SSIs after a hepatectomy for hepatolithiasis (11.9%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p < 0.001) and the incidence of superficial or deep incisional SSIs after a hepatectomy for HCC (7.8%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p = 0.050). There was a significant difference in the incidence of space/organ SSIs between the patients with hepatolithiasis (11.9%) and HCC patients (3.6%) (p = 0.029), and between the patients with hepatolithiasis and metastatic carcinoma patients (1.4%) (p < 0.001). The rate of positive bile culture was 36.2% in all patients in this study, and the rates were 83.3, 7.8, and 10.0% for patients with hepatolithiasis, HCC, and metastatic carcinoma, respectively. A significantly higher (p < 0.001) positive bile culture rate was observed in patients with hepatolithiasis as compared with HCC or metastatic carcinoma patients.Our study suggests the existence of a relationship between postoperative SSIs and bile infection, thus supporting the proposed relationship between post-hepatectomy infection and such variables as liver function, blood sugar control, and nutritional status.