胰十二指肠切除术后腹腔感染的危险因素分析-现代医学

胰十二指肠切除术后腹腔感染的危险因素分析

单位：1. 南京大学医学院附属鼓楼医院胰腺与代谢外科, 江苏南京 210008;
2. 南京中医药大学鼓楼临床医学院胰腺与代谢外科, 江苏南京 210008

分类号：R629

出版年·卷·期（页码）：2025·53·第七期（1088-1095）

摘要：

目的：探讨胰十二指肠切除术后出现腹腔感染的危险因素。方法：回顾性收集2018年1月至2021年3月南京大学医学院附属鼓楼医院收治的285例行胰十二指肠切除术的患者临床病例资料；根据是否出现腹腔感染，分为感染组和未感染组。观察指标：(1) 腹腔感染组和未感染组围术期相关指标及术后并发症比较；(2) 胰十二指肠切除术后发生腹腔感染的危险因素分析；(3) 胰十二指肠切除术后发生腹腔感染的病原菌分布。正态分布的计量资料以 x±s表示；偏态分布的资料M(Q₂₅，Q₇₅)表示；计数资料以绝对数和百分比表示；单因素采用t检验或Mann-Whitney U检验和多因素分析采用Logistic回归模型。结果：(1) 腹腔感染组和未感染组围术期相关指标及术后并发症比较：285例患者中，84例(29.5%)患者出现腹腔感染，其中腹腔感染组术前胆道引流比例、术前总胆红素、手术时长、胰管直径、术后出现临床相关性胰瘘、胆瘘、出血、Clavien-Dindo分级Ⅲ级以上并发症发生率显著高于非感染组(P<0.05)。(2) 胰十二指肠切除术后发生腹腔感染的危险因素分析：术前胆道引流(OR=3.143，95%CI 1.610～6.136)、手术时长(OR=2.215，95%CI 1.170～4.196)、术后出现临床相关性胰瘘(OR=13.723，95%CI 7.034～26.774)、胆瘘(OR=8.164，95%CI 2.414～27.605)是胰十二指肠切除术后出现腹腔感染的独立危险因素(均P<0.05)。(3) 胰十二指肠切除术后发生腹腔感染的病原菌分布：其中最多见的病原菌是肺炎克雷伯杆菌，其次是粪肠球菌、表皮葡萄球菌、屎肠球菌等。结论：术前胆道引流、手术时长、术后出现临床相关性胰瘘、胆瘘是胰十二指肠切除术后出现腹腔感染的独立危险因素。

Objective: To investigate the risk factors for postoperative abdominal infection following pancreaticoduodenectomy(PD).Methods: The clinical data of 285 patients who underwent PD in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2018 and March 2021 was collected and analyzed retrospectively. Patients were divided into infection group and non-infection group based on the occurrence of abdominal infection. Observed parameters included:(1) Comparison of perioperative indicators and postoperative complications between the two groups;(2) analysis of risk factors for abdominal infection after PD;(3) distribution of bacterial strains isolated from patients' drain samples. Continuous variables were compared using independent-samples t-test and described as mean±standard deviation(SD) when the data showed normal distribution. Mann-Whitney U test was used and expressed as median(interquartile range)(IQR) when they were not normally distributed. Categorical variables were compared using Chi-squared test or Fisher's exact test as appropriated, expressed as absolute number and percentage. Multivariate analysis was conducted by Logistic regression model. Results:(1) Comparison of perioperative variables and postoperative complications between the two groups: 84(29.5%) patients occurred abdominal infection after PD. The ratio of preoperative biliary drainage, preoperative total bilirubin, operation time, diameter of main pancreatic duct, the rate of clinically relevant postoperative pancreatic fistula, biliary leakage, post-pancreatectomy hemorrhage, major complication(Clavien-Dindo grade≥Ⅲ) were significantly higher in the abdominal infection group(P<0.05). (2) Analysis of risk factors of abdominal infection after PD: preoperative biliary drainage(OR=3.143，95%CI 1.610-6.136), operation time(OR=2.215，95%CI 1.170-4.196), clinically relevant postoperative pancreatic fistula(OR=13.723，95%CI 7.034-26.774)and biliary leakage(OR=8.164，95%CI 2.414-27.605)were independent risk factors for abdominal infection after PD(all P<0.05).(3) distribution of bacterial strains isolated from PD patients’ drain samples: the most common bacterial species isolated were Klebsiella pneumoniae, followed by Enterococcus faecium, Staphylococcus epidermidis, Enterococcus faecium. Conclusion: Preoperative biliary drainage, operation time, clinically relevant postoperative pancreatic fistula and biliary leakage were independent risk factors for abdominal infection after PD.

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