术中冲洗液在结直肠癌术后切口感染预防中的应用*

Application of washing fluid in preventing postoperative incisional infection of colorectal cancer*

摘要:

目的 探讨术中冲洗液对结直肠癌术后切口感染预防中的应用。方法 选取该院2012 年1 月- 2015 年12 月行结直肠癌腹腔镜手术病例350 例，随机分组，对患者术中分别使用无菌生理盐水、0.50% 甲硝 唑组、0.50% 聚维酮碘液组，同时部分冲洗液在使用前进行加温至37 ~ 38℃，记录手术时间、手术部位，术 后观察患者的切口感染情况，发生切口感染的患者，及时送分泌物做病原学检查；统计上采用单因素分析 和Logistic 多因素回归分析，分别对年龄、手术时间、手术部位、冲洗液种类、冲洗液温度行统计学分析。 结果 患者年龄≥ 60 岁、手术时间≥ 2 h 的切口感染率均高于年龄<60 岁、手术时间<2 h 的患者，差异有 统计学意义（P <0.05）；生理盐水组、0.50% 甲硝唑、0.50% 聚维酮碘液组，两两组间比较，0.50% 甲硝唑和 0.50% 聚维酮碘液组的感染率分别为7.69% 和8.55%，明显低于生理盐水组的16.38% ；使用加温后的冲洗液的 感染率低于常温冲洗液，分别为7.22% 和14.71%，差异有统计学意义（P <0.05）。结论 患者年龄≥ 60 岁、 手术时间≥ 2 h 均是结直肠癌行腹腔镜手术后切口感染的危险因素，而选择0.50% 甲硝唑、0.50% 聚维酮碘液 组和加温的冲洗液，是手术切口感染的保护性因素，可以应用到预防腹腔镜手术后切口感染中。

Abstract:

Objective To explore the application of washing fluid in the prevention of postoperative incision infection of colorectal cancer. Methods 350 patients with colorectal cancer underwent colorectal surgery from Jan. 2012 to Dec. 2015 were randomly divided into three groups: sterile saline, 0.50% metronidazole, 0.50% Povidoneiodine solution group, while part of the rinse liquid heated to 37 ~38 ℃ before use, then record the operation time, surgical site, postoperative incision infection, incision infection, timely delivery statistical analysis was performed by using single factor analysis and logistic multivariate regression analysis. Age, operation time, surgical site, type of irrigating fluid and temperature of flushing fluid were analyzed statistically. Results The incision infection rate of the patients ≥60 years old and the operation time ≥2 h was higher than the age <60 years, and the operation time was less than 2 h, P < 0.05, the difference was statistically significant; 0.50% metronidazole, 0.50% Povidoneiodine solution group, the infection rates of 0.50% metronidazole and 0.50% povidone-iodine group were 7.69% and 8.55%, respectively, which were significantly lower than those of the saline group 16.38% The infection rate of the rinsing fluid after heating was 7.22% and 14.71%, respectively, lower than that of the normal temperature rinsing solution (P < 0.05), the difference was statistically significant. Conclusions The risk factors of incisional infection in colorectal cancer patients with colorectal cancer were : ≥60 years of age and ≥2 h of operation, while 0.50% metronidazole, 0.50% povidone-iodine solution and heated washing fluid were protective factors. It can be applied to prevent incision infection after laparoscopic surgery.