目的 分析胃腸外科手術切口感染的影響因素,為醫院感染的防治提供理論依據。 方法 回顧性分析2010年12月-2012年12月764例行胃腸外科手術患者的臨床資料,并用單因素χ2檢驗統計分析患者醫院感染的危險因素。 結果 共有65例患者發生手術切口感染,其感染率為8.5%,且分離培養出合格菌株48株,陽性率73.8%,其中G?菌32株,占66.7%,G+菌16株,占33.3%。G?菌主要以大腸桿菌、變形桿菌、克雷伯桿菌和腸桿菌為主,分別占29.2%、18.8%、12.5%和6.2%;G+菌以腸球菌和表皮葡萄球菌為主,分別占22.9%和10.4%。單因素χ2檢驗顯示年齡>60歲、手術時間>120 min、術中有輸血、且有腫瘤病變的患者具有較高的切口感染發生率(P<0.05)。 結論 胃腸外科手術切口感染的主要致病菌是G?桿菌,患者的年齡、手術時間、術中輸血情況和疾病良惡性質是術后切口感染的高危因素,積極采取相應的預防措施有望減低其感染的發生率。
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.