Sakamoto Y, Tanimura H, Ishimoto K, Kawaguchi T, Ochiai M, Nishimoto N, Sakata Y
Department of Gastroenterological Surgery, Wakayama Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1991 Sep;92(9):1276-9.
Some factors relating to the increasing prevalence of postoperative infections after gastroenterological surgery were investigated from the standpoint of both patients profile and isolated bacteria. Data were collected from 542 cancer patients comprising 39 with esophagus cancer, 229 with gastric cancer, 149 with hepato-biliary tract and pancreatic cancer and 125 with colon cancer. Respiratory infections after operations were most frequently caused by aging, disturbance of glucose tolerance and respiratory dysfunction, whereas with intraabdominal abscess the major factors were disturbance of glucose tolerance, hepatic dysfunction and respiratory dysfunction in this order. Two factors in the management of patients during operation were singled out as mainly contributing to infection: these were prolonged operative time as in the case of esophagus cancer or hepato-biliary tract and pancreatic cancer, and massive intraoperative bleeding as in hepato-biliary tract, pancreatic and gastric cancer. As isolated bacteria, the most frequent clinical isolates were MRSA, Enterococcus, P. aeruginosa and Enterobacter, and it is noteworthy that all of these were strongly resistant to all antimicrobial agents. The greater emphasis on prevention control of postoperative infections, therefore, should be focussed on aging, preoperative risk factors, surgical stress and the kinds of antimicrobial agents administered.
从患者情况和分离出的细菌两个角度，对一些与胃肠外科手术后感染发生率增加相关的因素进行了调查。数据收集自542例癌症患者，其中39例为食管癌患者，229例为胃癌患者，149例为肝胆胰癌患者，125例为结肠癌患者。术后呼吸道感染最常见的原因依次为年龄增长、糖耐量异常和呼吸功能障碍，而腹腔内脓肿的主要因素依次为糖耐量异常、肝功能障碍和呼吸功能障碍。手术过程中患者管理方面有两个因素被认为是导致感染的主要原因：一是食管癌或肝胆胰癌手术时间延长，二是肝胆胰癌、胃癌手术中大量出血。作为分离出的细菌，最常见的临床分离株是耐甲氧西林金黄色葡萄球菌、肠球菌、铜绿假单胞菌和肠杆菌属，值得注意的是，所有这些菌株对所有抗菌药物均具有很强的耐药性。因此，对术后感染的预防控制应更加注重年龄增长、术前危险因素、手术应激以及所用抗菌药物的种类。
