结肠癌术后吻合口瘘合并腹腔感染危险因素分析
Risk Factors for Postoperative Anastomotic Leakage Complicated with Ab-dominal Infection in Patients with Colon Cancer
文家治 1向荣2
作者信息
- 1. 710018 西安,西安市长安医院普通外科
- 2. 723100 陕西汉中,汉中市中医医院普通外科
- 折叠
摘要
目的 探讨结肠癌术后吻合口瘘合并腹腔感染危险因素.方法 选取 2019 年 3 月至 2022 年 1 月 91例结肠癌根治术后发生吻合口瘘患者,根据术后是否并发腹腔感染分为2 组,其中观察组患者40 例为结肠癌根治术后吻合口瘘并发腹腔感染患者,对照组患者51 例为结肠癌术后吻合口瘘未并发腹腔感染患者.分析观察组患者病原菌分布特征,2 组术后第3 日降钙素原及C反应蛋白水平,采用二分类Logistic回归分析探讨结肠癌根治术后吻合口瘘并发腹腔感染的危险因素.结果 结肠癌根治术后吻合口瘘并发腹腔感染患者中,共检测到50 株病原菌,其中革兰阴性菌33 株,包括大肠杆菌12 株(24.0%)、克雷伯杆菌 9 株(18.0%)、铜绿假单胞菌 7 株(14.0%)、鲍曼不动杆菌3 株(6.0%)和阴沟肠杆菌2 株(4.0%);革兰阳性菌 12 株,包括表皮葡萄球菌 7 株(14.0%),金黄色葡萄球菌 3株(6.0%),肺炎链球菌1 株(2.0%),粪肠球菌1 株(2.0%);真菌5 株.观察组术后 3d降钙素原及C反应蛋白水平均显著高于对照组(P＜0.05).二分类Logistic回归分析显示,合并糖尿病、C反应蛋白及降钙素原是结肠癌患者术后吻合口瘘并发腹腔感染的危险因素,而白蛋白则是其保护因素(P＜0.05).结论 结肠癌根治术后吻合口瘘并发腹腔感染以革兰阴性菌感染为主,合并糖尿病、C反应蛋白及降钙素原是结肠癌患者术后吻合口瘘并发腹腔感染的危险因素,而白蛋白则为其保护因素.
Abstract
Objective To investigate the risk factors for postoperative anastomotic leakage complicated with abdomi-nal infection in patients with colon cancer.Methods From March 2019 to January 2022,91 patients with anastomotic leak-age after radical resection of colon cancer were selected and divided into two groups according to whether they were complicated with abdominal infection after operation.Forty patients in the research group were those with anastomotic leakage after radical resection of colon cancer complicated with abdominal infection,and 51 patients in the control group were those with anastomot-ic leakage after radical resection of colon cancer without abdominal infection.The distribution characteristics of pathogens in the research group,and the levels of procalcitonin and C reactive protein(CRP)on the third day after operation in the two groups were analyzed,and the risk factors of anastomotic leakage complicated with abdominal infection after radical resection of colon cancer were explored by binary logistic regression.Results A total of 50 strains of pathogenic bacteria were detected in patients with anastomotic leakage complicated with abdominal infection after radical resection of colon cancer,including 33 strains of Gram-negative bacteria,in which there were 12 strains of Escherichia coli(24.0%),9 strains of Klebsiella(18.0%),7 strains of Pseudomonas aeruginosa(14.0%),3 strains of Acinetobacter baumannii(6.0%)and 2 strains of Enterobacter cloacae(4.0%),12 strains of Gram-positive bacteria,in which there were 7 strains of Staphylococcus epidermi-dis(14.0%),3 strains of Staphylococcus aureus(6.0%),1 strain of Streptococcus pneumoniae(2.0%),1 strain of En-terococcus faecalis(2.0%),and 5 strains of fungi.The levels of procalcitonin and CRP in the research group were signifi-cantly higher than those in the control group at 3 d after operation(P＜0.05).Binary logistic regression analysis showed that combined diabetes mellitus,CRP and procalcitonin were the risk factors of postoperative anastomotic leakage complicated with abdominal infection in patients with colon cancer,while albumin was the protective factor(P＜0.05).Conclusion Gram-negative bacterial infection is the main risk factor for postoperative anastomotic leakage complicated with abdominal infection in patients after radical resection of colon cancer.Combined diabetes,CRP and procalcitonin are considered to be risk factors for postoperative anastomotic leakage complicated with abdominal infection in patients with coloncancer,while albumin is the pro-tective factor.
关键词
结肠肿瘤/吻合口瘘/腹腔感染/病原菌/C反应蛋白/降钙素原/影响因素分析Key words
Colon tumor/Anastomotic leakage/Abdominal infection/Pathogenic bacteria/C reactive protein/Pro-calcitonin/Analysis of influencing factor引用本文复制引用
基金项目
西安市科技计划项目(2022JH-YBYJ-0369)
出版年
2024
国家科技期刊平台
NSTL
万方数据