结直肠癌手术部位感染病原菌分布与影响因素分析.docVIP

结直肠癌手术部位感染病原菌分布与影响因素分析 　　[摘要] 目的 探讨结直肠癌患者手术切口感染病原菌的分布特点及影响因素。方法 采集伤口分泌物进行细菌培养，分离病原菌并进行鉴定；对结直肠癌手术患者的年龄、性别、体重指数（body mass index,BMI）、糖尿病及其他合并症、肿瘤分期等因素与切口手术部位感染的关系进行分析。结果300例结直肠癌患者，术后发生切口感染51例，发生率为17%。病原菌以革兰阴性杆菌为主，占58.1%，其中分离率最高的为大肠埃希菌（24.2%）、铜绿假单胞菌（11.3%）、鲍氏不动杆菌（9.7%）。合并肥胖或糖尿病患者切口感染的发生率显著升高。切口感染的发生率和Dukes分期密切相关。结论肥胖、糖尿病和Dukes分期是影响结直肠恶性肿瘤患者术后发生手术部位感染并发症的重要因素，必须采取切实的防治对策，预防与控制手术切口感染。 　　[关键词] 手术切口；感染；病原菌；结直肠肿瘤 　　[中图分类号]R735.3+7[文献标识码] B [文章编号]1673-9701（2011） 19-147-02 　　 　　Distribution of Pathogens from Infected Surgical Incision in Colorectal Cancer and Its Influence Factors 　　YAO Defeng 　　Department of General Surgery, Hangzhou Municipal West Lake District Second People’s Hospital, Hangzhou 310024, China 　　 　　[Abstract] Objctive To study the distribution of pathogens from infected surgical incision in colorectal cancer and its influence factor associated with incisional surgical site infection(SSI).Methods The secretion from infected incisions was cultured in order to identify pathogens by routine Methods.we resrospectively analyzed impacting factors of SSI including age,gender,BMI,diabetes mellitus and tumor staging in 300 colorectal patients. Results Most of the pathgens were Gram- negative bacilliaccounting for 58.1%, among which the isolation rates of Escherichia coli (24.2%),Pseudomonas aeruginosa (11.3%)and Acinetobacter baumannii (9.7%) were the highest .The incidences of SSI in patients with obesity and diabetes mellutus increased significantly（P＜0.05). Tumor staging was the related factor causing surgical site infections（P＜0.05). ConclusionObesity,diabetes mellitus and tumor staging are the most important factors associated with SSI in colorectal cancer patients. Preventive measures should be taken to prevent and control SSI. 　　[Key words]Surgical incision; Infection;Pathogen;Colorectal cancer 　　 　　结直肠癌是外科常见的肿瘤， 占我国恶性肿瘤的第三位,早期发现和早期诊断能明显提高生存率[1]。目前手术切除是治疗结直肠癌的主要手段，包括开腹手术和腹腔镜手术两种方式。腹部切口感染是手术的常见并发症，可导致切口延迟愈合，甚至切口脂肪液化和吻合口漏，给患者带来身心伤害和经济损失。为预防与控制手术切口感染，