Nakamura Takatoshi, Mitomi Hiroyuki, Ihara Atsushi, Onozato Wataru, Sato Takeo, Ozawa Heita, Hatade Kazuhiko, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
World J Surg. 2008 Jun;32(6):1138-41. doi: 10.1007/s00268-008-9528-6.
Among complications after surgery for colorectal cancer, wound infections may prolong hospitalization and increase healthcare costs. This study was designed to clarify the incidence, risk factors, and pathogens responsible for wound infections after surgery for colorectal cancer.
The study group comprised 144 patients (94 men and 50 women) with colorectal cancer in whom the same surgeon at Kitasato University Hospital performed resection from January 2004 through December 2005. Their mean age was 67.1 years (range = 38-90). To identify risk factors for surgical wound infections, we examined the following 11 variables: gender, age (>65 vs. <or=65 years), body-mass index (>25 vs. <or=25 kg/m(2)), the presence or absence of diabetes mellitus, physical status according to the American Society of Anesthesiologists classification (ASA score), stage of cancer according to the TNM staging system, surgical procedure (laparoscopic colectomy vs. open colectomy), procedure type (right colectomy vs. left colectomy vs. anterior resection), operation time (>180 vs. <or=180 min), intraoperative bleeding volume (>120 vs. <or=120 ml), and the presence or absence of intraoperative transfusion. Tissue specimens of infected wounds were cultured to identify pathogens.
Postoperative wound infections occurred in 12% (17/144) of the patients. In univariate analyses, the incidence of wound infection was 26% (11/43) in patients who underwent open colectomy compared with 6% (6/101) in those who underwent laparoscopic colectomy. This difference was significant (P = 0.001). In multivariate analyses, only surgical procedure was identified as an independent risk factor for wound infection. The odds ratio for open colectomy compared with laparoscopic colectomy was 3.322 (P = 0.021). Pus from infected wounds was cultured in 7 of the 17 patients and cultures were positive for pathogens in 5 patients: 1 laparoscopic colectomy and 4 open colectomy. Bacteroides species were the most common pathogen.
To prevent wound infections after surgery for colorectal cancer, laparoscopic surgery should be performed when indicated.
在结直肠癌手术后的并发症中，伤口感染可能会延长住院时间并增加医疗费用。本研究旨在阐明结直肠癌手术后伤口感染的发生率、危险因素及病原体。
研究组包括144例结直肠癌患者（94例男性和50例女性），这些患者于2004年1月至2005年12月在北里大学医院由同一位外科医生进行手术切除。他们的平均年龄为67.1岁（范围 = 38 - 90岁）。为了确定手术伤口感染的危险因素，我们检查了以下11个变量：性别、年龄（>65岁与≤65岁）、体重指数（>25 kg/m²与≤25 kg/m²）、是否患有糖尿病、根据美国麻醉医师协会分类的身体状况（ASA评分）、根据TNM分期系统的癌症分期、手术方式（腹腔镜结肠切除术与开放结肠切除术）、手术类型（右半结肠切除术与左半结肠切除术与前切除术）、手术时间（>180分钟与≤180分钟）、术中出血量（>120毫升与≤120毫升）以及是否有术中输血。对感染伤口的组织标本进行培养以鉴定病原体。
12%（17/144）的患者发生了术后伤口感染。在单因素分析中，接受开放结肠切除术的患者伤口感染发生率为26%（11/43），而接受腹腔镜结肠切除术的患者为6%（6/101）。这种差异具有统计学意义（P = 0.001）。在多因素分析中，只有手术方式被确定为伤口感染的独立危险因素。与腹腔镜结肠切除术相比，开放结肠切除术的优势比为3.322（P = 0.021）。17例患者中有7例对感染伤口的脓液进行了培养，其中5例培养出病原体阳性：1例腹腔镜结肠切除术和4例开放结肠切除术。拟杆菌属是最常见的病原体。
为预防结直肠癌手术后的伤口感染，如有指征应进行腹腔镜手术。
