Ge Xiaolong, Tang Shasha, Qi Weilin, Liu Wei, Lv Jiemin, Cao Qian, Zhou Wei, Cai Xiujun
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
Int J Colorectal Dis. 2019 May;34(5):879-887. doi: 10.1007/s00384-019-03275-5. Epub 2019 Mar 13.
Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn's disease (CD) after bowel resection.
This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared.
Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (≤ 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161-0.793, p < 0.05).
Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.
手术部位感染（SSIs）已成为手术中可预防的发病和死亡的主要原因。本研究旨在评估一种双环伤口保护器预防克罗恩病（CD）肠切除术后手术部位感染的疗效。
这项回顾性观察性研究纳入了2015年1月至2018年6月在浙江大学医学院附属邵逸夫医院炎症性肠病中心接受肠切除术的所有CD患者。通过单因素和多因素分析评估术前临床特征和围手术期治疗，以确定手术部位感染的危险因素。比较使用和未使用伤口保护器的CD患者的结局。
本研究共纳入344例CD患者，121例（35.2%）患者出现术后并发症，其中72例（20.9%）患者发生手术部位感染（12.8%为切口感染，8.1%为器官/腔隙感染）。伤口保护器组的切口感染发生率显著降低（8.1%对16.8%，p<0.05）。使用和未使用伤口保护器的组间器官/腔隙感染无显著差异（6.3%对9.8%，p=0.232）。切口感染与术前白蛋白、C反应蛋白、白细胞、年龄（≤16岁）、穿透性疾病行为、手术史、开放手术、造口术、估计失血量、英夫利昔单抗和伤口保护器相关（p<0.05）。多因素分析确定伤口保护器是预防切口感染SI的独立因素之一（OR 0.357，95%CI 0.161-0.793，p<0.05）。
在接受肠切除术的CD患者中，手术期间使用双环伤口保护器可显著降低切口感染的风险。
