胃癌术后手术部位感染的临床研究及思考

Clinical studies and reflection of postoperative surgical site infection in gastric cancer

  • 摘要: 手术部位感染(SSI)是胃癌术后常见的医院感染之一,其与住院时间延长、术后死亡和总体不良结局相关。尽管目前在降低SSI发生率方面取得重大进展,但其仍然是一种具有挑战性且治疗成本高昂的手术并发症。SSI通常在手术时由患者自身菌群中的病原体引起,其发生取决于暴露的细菌和宿主控制手术伤口细菌污染的能力。SSI发生的影响因素包括患者年龄、性别、先天免疫力、放化疗史以及患者自身的营养状况、肥胖程度、糖尿病史、吸烟史等;与手术相关的手术时间、手术技术、麻醉方式和切除方式开放和(或)腔镜有关。但是SSI可以预防,这包括术前抗菌药物使用、皮肤消毒、营养干预、血糖控制等;术中预防包括患者体温控制、高氧、切口和腹腔冲洗和闭合;术后伤口保护器以及敷料的使用。笔者查阅文献发现SSI预防措施的相关指南意见并不一致,建议关于这些预防策略的采纳应该根据医疗机构和外科医师的偏好采用规范的方法。

     

    Abstract: Surgical site infection (SSI) is one of the most prevalent hospital-acquired infections in patients with gastric cancer. It is related to prolonged hospital stay, postoperative mortality and overall poor outcomes. Despite significant progress has been made in reducing the incidence of SSI, it proceeds to be a challenging and costly surgical complication. SSI is primarily caused by pathogens inoculated from the patient's flora at the time of surgery, which depending on the bacteria exposed and the host's ability to control bacterial contamination of the surgical wound. Factors influencing the incidence of SSI include age, gender, innate immune system of patients, as well as history of radiotherapy and chemotherapy, nutritional status, extent of overweight, history of diabetes mellitus and history of smoking. Surgery-related factors such as the operation time, surgical techniques, mode of anesthesia and surgical approach (open surgery or laparoscopic surgery) also impact the incidence of SSI. It can decrease the incidence of SSI by using antibiotics, skin disinfec-tion, nutritional support, glucose management before the surgery, by temperature control, hyperoxia, incisional and abdominal irrigation and closure during the surgery, and by wound protection and dressing use after the surgery. Through literature review, the authors find that the relevant guidelines for SSI prevention are inconsistent. It is suggested that implementing of these preven-tative methods should base on institutional and surgeon preferences, and using a normative approach to make a decision.

     

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