胰十二指肠切除术后感染相关危险因素分析

Infection-related risk factor analysis after pancreaticoduodenectomy

关键词:  感染  危险因素  胰十二指肠切除术

Key words:  infection  risk factors  pancreaticoduodenectomy

摘要:

[摘要]　目的　探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)后发生感染的相关危险因素。　方法　回顾性分析2009年1月—2014年6月收治的118例行PD术病人的临床资料，将发生感染的病人作为感染组(21例)，未发生感染的病人作为对照组(97例)，对两组病人的一般情况、术前、术中及术后相关指标进行单因素分析，并将单因素分析有统计学意义的因素纳入多因素Logistic回归分析。　结果　引起PD术后感染的细菌主要有大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌。单因素分析示两组病人术后胰瘘、术后白蛋白、手术时间、术前胆红素、术后血红蛋白、围手术期输血、术后空腹血糖之间的差异有显著性意义(P<0.05)。多因素Logistic回归分析示，手术后胰瘘、术后低蛋白血症、手术时间、术后高血糖为PD术后发生感染的独立危险因素(P<0.05)。　结论　PD术中应缩短手术时间，预防术后胰瘘、低蛋白血症和高血糖，以避免术后感染发生。

Abstract:

[Abstract] Objective　To investigate infection-related risk factors after pancreaticoduodenectomy (PD).　Methods　Totally 118 patients,who received PD from 2009 January to 2014 June in our hospital,were retrospectively analyzed. 21 patients developed infection after surgery and were included in infection group; the remainder non-infection patients were classified as control group (97 cases). General information,preoperative,intraoperative and postoperative factors of patients in two groups were analyzed by single factor analysis and multivariate Logistic regression analysis.　Results　Bacteria were the main source of infection after PD including mainly Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,and Staphylococcus aureus. Single factor analysis showed that postoperative pancreatic fistula,postoperative albumin,operation time,preoperative bilirubin,postoperative hemoglobin,peri-operation blood transfusion and fasting blood glucose after operation were significantly different (P<0.05). Multivariate Logistic regression analysis showed that pancreatic leakage after operation,postoperative hypoproteinemia,operation time,postoperative hyperglycemia were independent risk factors of infection after PD (P<0.05).　Conclusion　It should be reducing the operation time and preventing pancreatic fistula,hypoproteinemia and hyperglycemia after operation to reduce the incidence of postoperative infection of PD.