高级检索

    腹腔镜胰十二指肠切除患者术后腹腔感染的病原学特征和危险因素分析

    Pathogenic characteristics and risk factors of postoperative abdominal infection in patients after laparoscopic pancreaticoduodenectomy

    • 摘要: 目的 分析腹腔镜胰十二指肠切除术(LPD)后腹腔感染的危险因素和病原学特点。方法 选择徐州医科大学附属医院肝胆外科2021年1月—2023年3月施行LPD的133例患者作为研究对象,观察患者术前白蛋白水平及是否减黄,手术时长及术中出血量,术后腹腔引流液培养结果、引流液淀粉酶及肺部和腹部影像学等指标,分析LPD后腹腔感染的病原学特点和危险因素。结果 38例患者LPD术后发生腹腔感染,感染发生率为28.6%。共检出病原菌83株,其中革兰阴性(G-)菌43株,革兰阳性(G+)菌38株,真菌2株。单因素分析发现,LPD术后腹腔感染与术前白蛋白水平、手术时长、术后肺部感染和胰瘘有关(P<0.05)。logistic回归分析显示,术前白蛋白低于30 g/L、胰瘘及肺部感染为LPD术后腹腔感染的独立危险因素。结论 LPD术后腹腔感染以G-菌为主,且大多呈多重耐药。控制LPD患者术前白蛋白水平、术后胰瘘及肺部感染是预防术后腹腔感染的重要举措。

       

      Abstract: Objective To analyze the risk factors and pathogenic characteristics of abdominal infection in patients after laparoscopic pancreaticoduodenectomy (LPD). Methods A total of 133 patients who underwent LPD between January 2021 and March 2023 at Department of Hepatobiliary Surgery, the Affiliated Hospital Xuzhou Medical University were selected as subjects. Before surgery, reduced jaundice, preoperative albumin levels, surgical duration, intraoperative blood loss, postoperative abdominal fluid culture results, drain amylase levels, and postoperative pulmonary and abdominal imaging findings, were observed. The pathogenic characteristics and risk factors of postoperative abdominal infection were analyzed. Results Abdominal infection occurred in 38 patients after LPD, with an infection rate of 28.6%. A total of 83 pathogenic strains were identified, including 43 Gram-negative (G-) bacteria, 38 Gram-positive (G+) bacteria, and 2 fungi. Univariate analysis showed that the occurrence of postoperative abdominal infection was associated with preoperative albumin level, surgical duration, postoperative pulmonary infection, and postoperative pancreatic fistula (P<0.05). Logistic regression analysis revealed that preoperative albumin levels <30 g/L, pancreatic fistula, and pulmonary infection were independent risk factors for postoperative abdominal infection following LPD. Conclusions Abdominal infection after LPD is predominantly caused by G- bacteria, most of which are multidrug-resistant. Preoperative albumin control and postoperative pancreatic fistula and pulmonary infection control, are crucial to prevent postoperative abdominal infection.

       

    /

    返回文章
    返回