标题：结肠癌根治术患者术后切口感染的病原菌分布及相关因素分析

      作者：杜建军 1，高金军 1，赵晶 2    西安医学院附属汉江医院外一科 1、检验科 2，陕西 汉中 723000

      卷次： 2019年30卷22期

      【摘要】 目的 探讨结肠癌根治术患者术后切口感染的病原菌分布及相关因素。方法 选取2017年1月至2019年1月西安医学院附属汉江医院收治的381例行结肠癌根治术后的患者作为研究对象，采集术后患者切口部位分泌物或引流液进行细菌培养，培养完成后对病原菌进行分离和鉴定；并对感染患者的年龄、性别、体质量指数(BMI)、吸烟史、手术方式、手术时间、Dukes分期等因素与切口感染的关系进行分析。结果 381例行结肠癌根治术后发生感染者61例，感染率为16.01%；61例感染患者共检出病原菌173株，革兰氏阴性菌为主要感染病原菌(64.74%)，其中革兰氏阴性菌以大肠埃希菌(37.57%)为主；革兰氏阳性菌(28.32%)以金黄色葡萄球菌(19.65%)为主；真菌(6.94%)以白色假丝酵母菌(4.05%)为主；单因素分析结果显示，患者年龄≥60岁、BMI≥25 kg/m2、吸烟史、开腹手术、手术时间≥80 min、住院时间≥10 d、糖尿病、Dukes≥C期均为结肠癌根治术后切口感染的相关因素(P<0.05)；多因素Logistic回归分析结果显示，BMI≥25 kg/m2、吸烟史、开腹手术、手术时间≥80 min、住院时间≥10 d、糖尿病、Dukes分期≥C期为结肠癌根治术后切口感染的危险因素(P<0.05)。结论 结肠癌根治术后切口感染的病原菌以革兰氏阴性菌中的大肠埃希菌为主，感染的发生与BMI、吸烟史、手术方式、手术时间、住院时间、糖尿病、Dukes分期等密切相关。
      【关键词】 结肠癌；根治术；感染；病原菌；分布；相关因素
      【中图分类号】 R735.3+5 【文献标识码】 A 【文章编号】 1003—6350（2019）22—2922—03

Pathogenic bacteria distribution and related factors of incision infection after radical resection of colon cancer.DU Jian-jun 1, GAO Jin-jun 1, ZHAO Jing 2.
First Department of General Surgery 1, Department of Clinical Laboratory 2,Hanjiang Hospital Affiliated to Xi'an Medical College, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To investigate the pathogenic bacteria distribution and related factors of incision infec-tion after radical resection of colon cancer. Methods From January 2017 to January 2019, 381 patients who underwentradical resection of colon cancer in Hanjiang Hospital Affiliated to Xi'an Medical College were selected as the study sub-jects. The secretions or drainage fluid of incision site were collected for bacterial culture, and the pathogens were isolat-ed and identified after culture. The abscess of incision or deep abscess after radical operation of colon cancer was collect-ed, the bacteria were cultured, and the pathogens were isolated and identified after culture. The relationship betweenbody mass index (BMI), smoking history, surgical treatment, operation time, Dukes stage and incision infection was ana-lyzed. Results Among 381 cases of colonic cancer, 61 cases had infection after radical operation, and the infection ratewas 16.01%. A total of 173 strains of pathogenic bacteria were detected from 61 cases of infected patients. Gram-nega-tive bacteria were the main pathogenic bacteria (64.74%). Escherichia coli (37.57%) was the main pathogen of Gram-neg-ative bacteria; Staphylococcus aureus (19.65%) was the main pathogen of Gram-positive bacteria (28.32%) and Candidaalbicans (4.05% ) was predominant in fungus (6.94% ). Univariate analysis showed that patients with age≥60 years,BMI≥25 kg/m2, smoking history, open surgery, operation time≥80 min, hospitalization time≥10 d, diabetes, Dukesstage≥C stage were all incision after colon cancer radical operation factors associated with infection (P<0.05). Multivar-iate logistic regression analysis showed that BMI ≥25 kg/m2, smoking history, open surgery, operation time≥80 min,hospitalization time≥10 d, diabetes, Dukes stage≥C stage were the risk factors for wound infection after radical resec-tion of colon cancer (P<0.05). Conclusion The pathogens of wound infection after radical resection of colon cancerare mainly Escherichia coli in Gram-negative bacteria. The occurrence of infection was closely related with BMI, smok-ing history, open surgery, operation time, hospitalization time, diabetes, Dukes staging, etc.
      【Key words】 Colon cancer; Radical operation; Infection; Pathogens; Distribution; Related factors