目的 分析胃肠外科手术切口感染的影响因素,为医院感染的防治提供理论依据。 方法 回顾性分析2010年12月-2012年12月764例行胃肠外科手术患者的临床资料,并用单因素χ2检验统计分析患者医院感染的危险因素。 结果 共有65例患者发生手术切口感染,其感染率为8.5%,且分离培养出合格菌株48株,阳性率73.8%,其中G−菌32株,占66.7%,G+菌16株,占33.3%。G−菌主要以大肠杆菌、变形杆菌、克雷伯杆菌和肠杆菌为主,分别占29.2%、18.8%、12.5%和6.2%;G+菌以肠球菌和表皮葡萄球菌为主,分别占22.9%和10.4%。单因素χ2检验显示年龄>60岁、手术时间>120 min、术中有输血、且有肿瘤病变的患者具有较高的切口感染发生率(P<0.05)。 结论 胃肠外科手术切口感染的主要致病菌是G−杆菌,患者的年龄、手术时间、术中输血情况和疾病良恶性质是术后切口感染的高危因素,积极采取相应的预防措施有望减低其感染的发生率。
Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.