Fusconi Massimo, Gallo Andrea, Vitiello Cecilia, Pagliuca Giulio, Pulice Gianna, de Vincentiis Marco
Department of Otorhinolaryngology "Giorgio Ferreri", La Sapienza University of Rome, Italy.
Arch Otolaryngol Head Neck Surg. 2006 Sep;132(9):953-7. doi: 10.1001/archotol.132.9.953.
To evaluate the risk of surgical wound infection (the most common complication in neoplastic clean-contaminated neck surgery) due to 10 intrinsic risk factors and 5 extrinsic risk factors.
Retrospective clinical study.
Academic tertiary referral medical center.
The study group included 115 patients with laryngeal carcinomas referred to our department from January 1, 1996, to August 31, 2002.
Fifty-seven patients underwent total laryngectomy and 58 underwent subtotal laryngectomy.
The association between surgical wound infection due to 10 intrinsic risk factors and 5 extrinsic risk factors was evaluated with multivariate models.
Surgical wound infection occurred in 27 patients (23.5%). There was no significant increase in the incidence of infection in patients with extensive tumors (P>.20) and in patients undergoing total laryngectomy and subtotal laryngectomy (P>.20). The incidence of infection was significantly higher in patients with stage IV disease (P<.01), in patients who underwent neck dissections (P<.05), and in those presenting with lymph node metastases (P<.001). Multivariate analysis showed that the presence of higher tumor stage is the best predictor of infection because it is the only significant factor (P<.03) even when adjusting for others. The association between infection and the other factors considered in this study (age [P>1.0], underweight [P = .26], anemia [P = .84], lymphocytopenia [P = .79 by Fisher exact test], number of preoperative hospitalizations [P<1.0], preoperative radiotherapy [P = .57 by Fisher exact test], diabetes mellitus [P = .70 by Fisher exact test], cirrhosis, resection margins infiltrated by the tumor [P = .57 by Fisher exact test], and myocutaneous flap reconstructions [P = .82]) was not significant.
The risk of surgical wound infection is correlated with a higher tumor stage and lymph node metastases; it is not associated with the extent of surgery or other factors considered.
评估10个内在危险因素和5个外在危险因素导致手术伤口感染（肿瘤清洁-污染颈部手术中最常见的并发症）的风险。
回顾性临床研究。
学术性三级转诊医疗中心。
研究组包括1996年1月1日至2002年8月31日转诊至我科的115例喉癌患者。
57例行全喉切除术，58例行次全喉切除术。
采用多变量模型评估10个内在危险因素和5个外在危险因素与手术伤口感染之间的关联。
27例患者（23.5%）发生手术伤口感染。广泛肿瘤患者（P>0.20）以及行全喉切除术和次全喉切除术的患者（P>0.20）感染发生率无显著增加。IV期疾病患者（P<0.01）、行颈部清扫术的患者（P<0.05）以及有淋巴结转移的患者（P<0.001）感染发生率显著更高。多变量分析显示，肿瘤分期较高是感染的最佳预测因素，因为即使在对其他因素进行调整后，它仍是唯一的显著因素（P<0.03）。本研究中考虑的其他因素（年龄[P>1.0]、体重过轻[P = .26]、贫血[P = .84]、淋巴细胞减少[Fisher精确检验P = .79]、术前住院次数[P<1.0]、术前放疗[Fisher精确检验P = .57]、糖尿病[Fisher精确检验P = .70]、肝硬化、肿瘤浸润切缘[Fisher精确检验P = .57]以及肌皮瓣重建[P = .82]）与感染之间的关联不显著。
手术伤口感染风险与较高的肿瘤分期和淋巴结转移相关；与手术范围或其他考虑因素无关。
Zotero 插件