Kamizono Kenichi, Sakuraba Minoru, Nagamatsu Shogo, Miyamoto Shimpei, Hayashi Ryuichi
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan,
Ann Surg Oncol. 2014 May;21(5):1700-5. doi: 10.1245/s10434-014-3498-8. Epub 2014 Feb 15.
Surgical site infections (SSIs) occur at a rate exceeding 40 % after head and neck reconstruction and are due in part to the clean-contaminated surgical field, in which cutaneous fields interact with oral or pharyngeal fields. The aim of this study was to clarify the most important risk factors for SSI and to identify effective strategies for preventing SSI.
In 2011 and 2012, 197 patients who underwent head and neck reconstructive surgery were studied at National Cancer Center Hospital East, Japan. The SSI rate, risk factors for SSI, and biological aspects of SSI were evaluated prospectively.
A total of 42 patients (21.3 %) had SSIs, and 62 bacterial species were identified at infection sites. Significant risk factors for SSI identified with multivariate analysis were hypoalbuminemia [P = 0.002, odds ratio (OR) = 3.37], reconstruction with vascularized bone transfer (P = 0.006, OR = 3.99), and a poor American Society of Anesthesiologists Physical Status score (P = 0.041, OR = 3.00). Most bacteria identified were species that persist around cutaneous and pharyngeal fields, but multidrug-resistant bacteria were rare.
The SSI rate at our hospital is lower than rates in previous studies. To minimize SSI, intervention to improve the patient's perisurgical nutritional status and a more appropriate mandible reconstructive strategy should be considered.
头颈部重建术后手术部位感染（SSI）发生率超过40%，部分原因是手术区域为清洁-污染区域，皮肤区域与口腔或咽腔区域相互接触。本研究旨在明确SSI最重要的危险因素，并确定预防SSI的有效策略。
2011年和2012年，对日本国立癌症中心东医院197例行头颈部重建手术的患者进行研究。前瞻性评估SSI发生率、SSI危险因素及SSI的生物学特征。
共有42例患者（21.3%）发生SSI，在感染部位鉴定出62种细菌。多因素分析确定的SSI显著危险因素为低白蛋白血症[P = 0.002，比值比（OR）= 3.37]、带血管蒂骨移植重建（P = 0.006，OR = 3.99）和美国麻醉医师协会身体状况评分较差（P = 0.041，OR = 3.00）。鉴定出的大多数细菌是在皮肤和咽腔区域周围持续存在的菌种，但多重耐药菌很少见。
我院的SSI发生率低于既往研究。为使SSI最小化，应考虑采取干预措施改善患者围手术期营养状况，并采用更合适的下颌骨重建策略。
