Nitta Hidetoshi, Beppu Toru, Itoyama Akari, Higashi Takaaki, Sakamoto Keita, Nakagawa Shigeki, Mima Kosuke, Okabe Hirohisa, Imai Katsunori, Hayashi Hiromitsu, Hashimoto Daisuke, Chikamoto Akira, Ishiko Takatoshi, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
J Hepatobiliary Pancreat Sci. 2015 Feb;22(2):166-76. doi: 10.1002/jhbp.175. Epub 2014 Oct 22.
This study was designed to investigate the association between infectious ascites, clinical parameters and treatment outcomes after hepatectomy.
Of 891 patients who underwent hepatectomy between 2006 and 2013, 74 who underwent paracentesis for bacterial cultivation of postoperative ascites after hepatectomy were analyzed.
Of the 74 patients, 42 had positive bacterial cultures (positive group) and 32 patients had negative cultures (negative group). Hospital mortality was significantly higher in the positive group than in the negative group [9/42 (21.4%) vs. 2/32 (6.3%); P = 0.035]. Hospital mortality associated with each bacterial strain was as follows: methicillin-resistant staphylococci (MRS) (5/13, 38.5%), staphylococci (2/11, 18.2%), enterococci (2/12, 16.7%), Enterobacter (0/3, 0%), Klebsiella (0/2, 0%), and others (0/1, 0%). Cox proportional multivariate analysis revealed that MRS infection in ascites was the only risk factor of hospital death (HR = 5.08, P = 0.041) and MRS wound infection was the only risk factor to predict MRS infection in ascites (HR = 5.67, P = 0.015).
Postoperative MRS infection in postoperative ascites after hepatectomy is a potentially fatal complication; therefore, the prevention of MRS wound infection is critical to decrease postoperative hospital mortality.
本研究旨在调查肝切除术后感染性腹水、临床参数与治疗结果之间的关联。
在2006年至2013年间接受肝切除术的891例患者中，对74例在肝切除术后进行腹腔穿刺以培养术后腹水细菌的患者进行了分析。
在这74例患者中，42例细菌培养呈阳性（阳性组），32例培养呈阴性（阴性组）。阳性组的医院死亡率显著高于阴性组[9/42（21.4%）对2/32（6.3%）；P = 0.035]。与每种细菌菌株相关的医院死亡率如下：耐甲氧西林葡萄球菌（MRS）（5/13，38.5%）、葡萄球菌（2/11，18.2%）、肠球菌（2/12，16.7%）、肠杆菌（0/3，0%）、克雷伯菌（0/2，0%）和其他（0/1，0%）。Cox比例多变量分析显示，腹水中的MRS感染是医院死亡的唯一危险因素（HR = 5.08，P = 0.041），而MRS伤口感染是预测腹水中MRS感染的唯一危险因素（HR = 5.67，P = 0.015）。
肝切除术后腹水中的术后MRS感染是一种潜在的致命并发症；因此，预防MRS伤口感染对于降低术后医院死亡率至关重要。
