Nanashima Atsushi, Abo Takafumi, Arai Junichi, Oyama Shousaburo, Mochinaga Koji, Matsumoto Hirofumi, Takagi Katsunori, Kunizaki Masaki, To Kazuo, Takeshita Hiroaki, Hidaka Shigekazu, Nagayasu Takeshi
Hepatogastroenterology. 2014 Sep;61(134):1739-43.
BACKGROUND/AIMS: To clarify parameters associated with postoperative surgical site infection (SSI) after pancreatectomy, we examined clinicopathological and surgical records in 186 patients who underwent pancreatectomy at a single academic institute.
Patient demographics, liver functional parameters, histological findings, surgical records and post-hepatectomy outcomes during hospitalization were compared between the non-SSI and SSI group, in which SSIs included superficial and deep SSIs.
The prevalence of SSI (29-35%) has not changed over an 18-year period. With respect to patient demographics and laboratory data, no parameters were associated with postoperative SSI. In surgical records, the operating time in the SSI group tended to be longer in comparison with that in the non- SSI group (618 vs. 553 minutes, respectively) but not significantly different (p=0.070). With respect to postoperative outcomes, time to oral intake in the SSI group was significantly longer than that in the non-SSI group (21.2 vs. 13.7 days, respectively) (p<0.01). Incidences of pancreatic fistula, postoperative bleeding, long-term ascites and re-operation were significantly more frequent in the SSI group in comparison with the non-SSI group (p<0.05). Decrease of body weight after surgery in the SSI group was significantly greater than that in the non- SSI group (-4.1 vs. -2.7kg, respectively) (p<0.05). Period of hospital stay in the SSI group was significantly longer than that in the non-SSI group (37 vs. 25 days) (p<0.05). Multivariate analysis showed that only postoperative pancreatic fistula was significantly associated with SSI (p<0.01).
SSI is an important risk factor of longer hospital stay after pancreatectomy and prevention of pancreatic fistula through the future improvement of surgical procedures is necessary to decrease SSI rates.
背景/目的：为明确胰腺切除术后手术部位感染（SSI）的相关参数，我们对在一家学术机构接受胰腺切除术的186例患者的临床病理及手术记录进行了研究。
比较非SSI组和SSI组（SSI包括表浅和深部SSI）患者的人口统计学资料、肝功能参数、组织学检查结果、手术记录及肝切除术后住院期间的转归。
18年间SSI的发生率（29%-35%）未发生变化。在患者人口统计学资料和实验室数据方面，无参数与术后SSI相关。手术记录显示，SSI组的手术时间相较于非SSI组有延长趋势（分别为618分钟和553分钟），但差异无统计学意义（p = 0.070）。术后转归方面，SSI组开始经口进食的时间显著长于非SSI组（分别为21.2天和13.7天）（p<0.01）。SSI组胰瘘、术后出血、长期腹水及再次手术的发生率显著高于非SSI组（p<0.05）。SSI组术后体重下降显著大于非SSI组（分别为-4.1kg和-2.7kg）（p<0.05）。SSI组的住院时间显著长于非SSI组（37天对25天）（p<0.05）。多因素分析显示，仅术后胰瘘与SSI显著相关（p<0.01）。
SSI是胰腺切除术后住院时间延长的重要危险因素，通过未来改进手术操作来预防胰瘘对于降低SSI发生率很有必要。
