Sagawa Masano, Yoshimatsu Kazuhiko, Yokomizo Hajime, Yano Yuki, Okayama Sachiyo, Yamada Yasufumi, Usui Takebumi, Yamaguchi Kentaro, Shiozawa Shunichi, Shimakawa Takeshi, Katsube Takao, Kato Hiroyuki, Naritaka Yoshihiko
Department of Surgery, Tokyo Women's Medical University Medical Center East.
Department of Clinical Laboratory, Tokyo Women's Medical University Medical Center East.
J Nippon Med Sch. 2018;85(4):208-214. doi: 10.1272/jnms.JNMS.2018_85-32.
We evaluated the preoperative patient status including nutrition, immunity, and inflammation as a predictive factor of remote infection (RI) in colorectal cancer surgery.
A total of 351 patients who underwent colorectal cancer resection were retrospectively analyzed. Factors correlated with RI incidence were identified by logistic analysis and stepwise selection.
RI occurred in 27 patients, with an incidence of 7.7%. In univariate logistic analysis, a significantly high incidence of RI was associated with excessive blood loss (>423 mL), long duration of surgery (>279 minutes), ileus, pulmonary dysfunction, performance status (PS) ≥1, American Society of Anesthesiologists (ASA) classification>2, prognostic nutritional index (PNI) ≤40, and controlling nutritional status (CONUT) ≥2, modified Glasgow Prognostic Score (mGPS) (Score 2).In multivariate analysis, pulmonary dysfunction (odds ratio=2.83; 95% CI: 1.14-6.97; p=0.02) and PNI≤40 (odds ratio=3.87; 95% CI: 1.45-10.31; p=0.006) were independent risk factors of RI incidence.
RI is caused by poor nutrition, immune system dysfunction and pulmonary dysfunction.
我们评估了术前患者的营养、免疫和炎症状态，将其作为结直肠癌手术中远处感染（RI）的预测因素。
对351例行结直肠癌切除术的患者进行回顾性分析。通过逻辑分析和逐步选择确定与RI发生率相关的因素。
27例患者发生RI，发生率为7.7%。单因素逻辑分析显示，RI的高发生率与失血过多（>423 mL）、手术时间长（>279分钟）、肠梗阻、肺功能障碍、体能状态（PS）≥1、美国麻醉医师协会（ASA）分级>2、预后营养指数（PNI）≤40、控制营养状态（CONUT）≥2、改良格拉斯哥预后评分（mGPS）（评分2）有关。多因素分析显示，肺功能障碍（比值比=2.83；95%可信区间：1.14-6.97；p=0.02）和PNI≤40（比值比=3.87；95%可信区间：1.45-10.31；p=0.006）是RI发生率的独立危险因素。
RI是由营养状况差、免疫系统功能障碍和肺功能障碍引起的。
