肝外胆管切除的大肝叶切除术后由多重耐药病原体引起的感染性并发症。

Postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection.

机构信息

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Surgery. 2020 Jun;167(6):950-956. doi: 10.1016/j.surg.2020.02.015. Epub 2020 Apr 14.

DOI:10.1016/j.surg.2020.02.015

PMID:32303347

Abstract

BACKGROUND

Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with extrahepatic bile duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens.

METHODS

Medical records of consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection between 2006 and 2017 were retrospectively reviewed.

RESULTS

Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P < .001). With multivariate analysis, the presence of preoperative cholangitis, the extent of liver resection more than 50%, operative time longer than 600 minutes, the amount of blood loss more than 1500 mL, and the presence of postoperative infectious complications caused by multidrug-resistant pathogens were identified as independent risk factors for postoperative death. The presence of multidrug-resistant pathogens in preoperative bile culture, the amount of blood loss greater than 1500 mL, the presence of bile leakage, and pancreatic fistula were identified as independent risk factors for postoperative infectious complications caused by multidrug-resistant pathogens.

CONCLUSION

The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with extrahepatic bile duct resection.

摘要

背景

鲜有报道探讨多重耐药病原体引起的术后感染性并发症。本研究旨在回顾分析行肝外胆管切除的大范围肝切除术患者的手术结局，并阐明多重耐药病原体引起的术后感染性并发症的发生率和危险因素。

方法

回顾性分析 2006 年至 2017 年间连续行大范围肝切除术加肝外胆管切除术的患者的病历资料。

结果

在 620 例研究患者中，219 例发生术后感染性并发症，其中 62 例（10.0%）由多重耐药病原体引起。62 例由多重耐药病原体引起的术后感染性并发症患者的死亡率（n=8，12.9%）高于 157 例由非多重耐药病原体引起的术后感染性并发症患者（n=2，1.3%）（P<.001）。多变量分析显示，术前胆管炎、肝切除范围超过 50%、手术时间超过 600 分钟、出血量超过 1500 mL 以及由多重耐药病原体引起的术后感染性并发症是术后死亡的独立危险因素。术前胆汁培养中存在多重耐药病原体、出血量超过 1500 mL、胆漏和胰瘘是由多重耐药病原体引起的术后感染性并发症的独立危险因素。