肝胆管结石患者肝部分切除术后腹腔感染危险因素分析

Analysis of risk factors for intraabdominal infections in patients after partial hepatectomy for hepatolithiasis

摘要:

背景与目的 腹腔感染是肝胆管结石患者肝部分切除术后常见的并发症，将增加患者痛苦和治疗费用，延长住院时间，甚至造成感染性休克，危及生命。本研究通过回顾性分析探讨此类患者肝部分切除术后腹腔感染发生的危险因素，为预防术后腹腔感染提供依据。方法 回顾性分析2017年3月—2021年2月中国人民解放军海军陆战队医院收治的54例行肝部分切除术治疗肝胆管结石患者的临床资料，对可能导致术后腹腔感染发生的危险因素先进行单因素分析，将有统计学意义的因素进一步应用多因素Logistic回归分析。结果 54例患者中，8例（14.8%）患者术后发生腹腔感染并发症，无再手术病例，均治愈。单因素分析显示年龄≥60岁（χ²=7.091，P=0.008）、术前血清白蛋白（ALB）水平<35 g/L（χ²=7.858，P=0.005）、术野冲洗水量<2 L（χ²=6.291，P=0.012）与术后腹腔感染并发症发生有关；进一步Logistic回归分析显示，高龄（P=0.025）、术前低ALB水平（P=0.044）、术野冲洗水量<2 L（P=0.019）是术后腹腔感染并发症发生的独立危险因素。结论 肝内胆管结石患者肝部分切除术后腹腔感染发生率较高，高龄（≥60岁）、术前低ALB水平（<35 g/L）、术野冲洗水量不足（<2 L）是其发生的独立危险因素，因此，改善术前ALB水平及术中充分冲洗术野有利于预防术后腹腔感染的发生。

Abstract:

Background and Aims Intraabdominal infections are common complications in patients after partial hepatectomy for hepatolithiasis, which will increase patient pain and treatment costs, prolong hospital stays, and even cause life-threatening infectious shock. This study was performed to determine the risk factors for the occurrence of intraabdominal infections after partial hepatectomy in such patients through a retrospective analysis, so as to provide a basis for the prevention of postoperative intraabdominal infections.Methods The clinical data of 54 patients with hepatolithiasis undergoing partial hepatectomy in the Hospital of the Marine Corps of PLA from March 2017 to February 2021 were retrospectively analyzed. A univariate analysis was performed on the factors that may affect the occurrence of postoperative intraabdominal infections, and then the factors with statistical significance were further identified by multivariate Logistic regression analysis.Results Of the 54 patients, postoperative intraabdominal infections occurred in 8 cases (14.8%), and none of them required a re-operation, and all were cured. Univariate analysis showed that the age ≥60 years (χ²=7.091, P=0.008), the preoperative serum albumin (ALB) level <35 g/L (χ²=7.858, P=0.005), and the fluid volume of the surgical field flush <2 L (χ²=6.291, P=0.012) were associated with the occurrence of postoperative intraabdominal infections; further Logistic regression analysis revealed that the advanced age (P=0.025), low preoperative ALB level (P=0.044), and low fluid volume of the surgical field flush (P=0.019) were independent risk factors for the development of postoperative intraabdominal infections.Conclusion The incidence of intraabdominal infections is relatively high after partial hepatectomy for hepatolithiasis. The advanced age (≥ 60 years), low preoperative ALB level (<35 g/L) and insufficient the amount of the surgical field flush (<2 L) are the independent risk factors for the occurrence of postoperative intraabdominal infections. Thus, improving the preoperative ALB level and adequate intraoperative surgical field flush are helpful for preventing the occurrence of intraabdominal infections.