Yaegashi Mizunori, Otsuka Koki, Kimura Toshimoto, Hakozaki Masanori, Kamishima Megumu, Hatanaka Tomoki, Sato Kei, Fujii Hitoshi, Matsuo Teppei, Sasaki Akira
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
Int J Colorectal Dis. 2017 May;32(5):715-722. doi: 10.1007/s00384-017-2753-4. Epub 2017 Jan 13.
Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent surgical site infection (SSI). No reports have detailed the relationship between SSI and umbilical microflora following laparoscopic colorectal cancer with a transumbilical longitudinal incision.
Risk factors and the rate of SSI were investigated in 453 patients who underwent laparoscopic colorectal resection over a 3-year period. Microbiological samples were collected from the umbilicus and SSI areas.
After laparoscopic procedure, we observed SSIs in approximately 5% of cases, with superficial SSI in 15 (3.3%) patients and organ/space SSIs 7 (1.5%). In univariate analysis, preoperative albumin (Alb) value and anastomosis of enterocolostomy were significantly associated with superficial SSI development. Also, age, blood loss, stoma, tumor site (rectum), and Hartmann/abdominal perineal resection (APR) were significant risk factors for organ/space SSI. In multivariate analysis, the preoperative Alb value was the most significant factor associated with a predisposition to superficial SSI. The bacteria detected in SSI were mostly different from those at wound closure. Antibiotic-resistant bacteria were included in organ/space SSI all cases.
SSI development with laparoscopic surgery reportedly occurs in about 3-15% cases. The SSI rate in this study and other reports was comparable. Using small transumbilical longitudinal incision in laparoscopic colorectal surgery is less likely to cause SSI when sufficient control measures are enacted, even though the umbilicus contains resident bacteria in abundance.
除抗生素预防外，皮肤消毒准备是预防手术部位感染（SSI）的重要措施。目前尚无报告详细阐述经脐纵向切口的腹腔镜结直肠癌手术后SSI与脐部微生物群之间的关系。
对453例在3年期间接受腹腔镜结直肠切除术的患者的SSI危险因素和发生率进行了调查。从脐部和SSI区域采集微生物样本。
腹腔镜手术后，我们观察到约5%的病例发生了SSI，其中15例（3.3%）为浅表SSI，7例（1.5%）为器官/腔隙SSI。在单因素分析中，术前白蛋白（Alb）值和小肠结肠造口吻合术与浅表SSI的发生显著相关。此外，年龄、失血量、造口、肿瘤部位（直肠）以及Hartmann/腹会阴切除术（APR）是器官/腔隙SSI的重要危险因素。在多因素分析中，术前Alb值是与浅表SSI易感性相关的最显著因素。在SSI中检测到的细菌大多与伤口闭合时的细菌不同。所有器官/腔隙SSI病例中均包含耐抗生素细菌。
据报道，腹腔镜手术的SSI发生率约为3%-15%。本研究中的SSI发生率与其他报告相当。在腹腔镜结直肠手术中使用小的经脐纵向切口，即使脐部含有大量常驻细菌，在采取充分的控制措施时也不太可能导致SSI。
