Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan.
J Hepatobiliary Pancreat Sci. 2013 Feb;20(2):186-96. doi: 10.1007/s00534-011-0503-5.
Surgical site infections (SSIs), particularly organ/space SSIs, remain a common cause of major morbidity after hepatectomy for hepatocellular carcinoma (HCC).
Risk factors for SSIs were analyzed in 359 patients who underwent hepatectomy for HCC between 2001 and 2010. The causative bacteria, management, outcome, and characteristics of organ/space SSIs were investigated.
Anatomic hepatectomy was performed for 296 patients (82.5%), and repeat hepatectomy was carried out for 59 patients (16.4%). SSIs developed in 52 patients (14.5%; incisional, 24 cases; organ/space, 31 cases [3 patients showed both incisional and organ/space SSIs]). No in-hospital mortality related to incisional or organ/space SSIs was encountered. Independent risk factors for SSIs were repeat hepatectomy and operative time ≥ 280 min. Independent risk factors for organ/space SSIs were repeat hepatectomy and bile leakage. Methicillin-resistant Staphylococcus aureus was detected more frequently in organ/space SSIs after repeat hepatectomy than after initial hepatectomy.
Repeat hepatectomy and bile leakage represent independent risk factors for organ/space SSIs after hepatectomy for HCC. Establishing treatment strategies is important for preventing postoperative bile leakage and reducing the high rate of organ/space SSIs after repeat hepatectomy.
手术部位感染（SSI），尤其是器官/腔隙 SSI，仍然是肝癌（HCC）患者肝切除术后发生严重发病率的常见原因。
分析了 2001 年至 2010 年间 359 例 HCC 患者行肝切除术后 SSI 的危险因素。调查了 SSI 的病原菌、处理方法、结果以及器官/腔隙 SSI 的特征。
296 例患者（82.5%）行解剖性肝切除术，59 例患者（16.4%）行重复肝切除术。52 例患者（14.5%；切口感染 24 例，器官/腔隙感染 31 例[3 例患者同时出现切口和器官/腔隙 SSI]）发生 SSI。未发生与切口或器官/腔隙 SSI 相关的院内死亡。SSI 的独立危险因素是重复肝切除术和手术时间≥280 分钟。器官/腔隙 SSI 的独立危险因素是重复肝切除术和胆漏。与初次肝切除术后相比，重复肝切除术后耐甲氧西林金黄色葡萄球菌在器官/腔隙 SSI 中更常见。
重复肝切除术和胆漏是 HCC 患者肝切除术后发生器官/腔隙 SSI 的独立危险因素。制定治疗策略对于预防术后胆漏和降低重复肝切除术后器官/腔隙 SSI 的高发生率很重要。
