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中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 150 -153. doi: 10.3877/cma.j.issn.1674-392X.2019.02.013

所属专题: 文献

论著

成人腹股沟疝无张力修补术后切口感染分析
陈洁1, 赵红1, 李瑞博1, 田磊2,(), 吕伟2   
  1. 1. 100088 北京,解放军火箭军总医院特色医学中心
    2. 100088 北京,解放军火箭军总医院普外科
  • 收稿日期:2018-11-12 出版日期:2019-04-18
  • 通信作者: 田磊

Analysis of wound infection after tension-free inguinal hernia repair in adults

Jie Chen1, Hong Zhao1, Ruibo Li1, Lei Tian2,,(), Wei Lyu2   

  1. 1. Characteristic Medical Center, General Hospital of the PLA Rocket Force, Beijing 100088, China
    2. Department of General Surgery, General Hospital of the PLA Rocket Force, Beijing 100088, China
  • Received:2018-11-12 Published:2019-04-18
  • Corresponding author: Lei Tian
  • About author:
    Corresponding author: Tian Lei, Email:
引用本文:

陈洁, 赵红, 李瑞博, 田磊, 吕伟. 成人腹股沟疝无张力修补术后切口感染分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(02): 150-153.

Jie Chen, Hong Zhao, Ruibo Li, Lei Tian, Wei Lyu. Analysis of wound infection after tension-free inguinal hernia repair in adults[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(02): 150-153.

目的

探讨成人腹股沟疝无张力疝修补术后切口感染的高危因素和预防方式。

方法

回顾性分析2016年10月至2018年5月,火箭军总医院226例腹股沟疝患者的临床资料,本组患者均行无张力疝修补术。分析术后切口感染情况,及引起术后感染的相关因素。

结果

患者均顺利完成手术,切口感染患者18例(7.96%)。急性嵌顿疝患者用过补片与未用过补片感染情况比较,差异有统计学意义(P<0.05);围手术期预防性使用抗生素与否对切口感染影响明显,且差异有统计学意义(P<0.05);患者自身因素、术前切口的微环境和手术操作对切口感染不明显,差异无统计学意义(P>0.05)。术后手术部位感染病原体培养,病原体分离革兰阳性菌11株(61.11%),革兰阴性菌7株(38.89%),白色念珠菌感染1株(5.56%)。药敏试验结果显示金黄色葡萄球菌为代表的革兰阳性菌对青霉素类和磺胺甲噁唑/甲氧苄啶呈较高的耐药率,以鲍曼不动杆菌为代表的革兰阴性菌普遍对氨苄西林的耐药率较高;白色念珠菌对咪康唑耐药率100%,对氟康唑、伊曲康唑、益康唑和制霉菌素耐药率均为0。

结论

预防腹股沟疝无张力疝修补术后切口感染的重点在于针对不同高危因素采取有效的预防措施,术后感染期选择适合抗生素进行治疗。

Objective

To investigate the risk factors and prevention of incision infection after tension-free repair of inguinal hernia in adults.

Methods

A retrospective analysis was performed on 226 patients with inguinal hernia admitted to General Hospital of the PLA Rocket Force from October 2016 to May 2018, who underwent tension-free hernia repair.

Results

All patients were successfully operated, and 18 patients (7.96%) were infected with the incision. The infection developed in patients with acute incarcerated hernia who used mesh and didn’t use patch were compared, and the difference was statistically significant (P<0.05). The prophylactic use of antibiotics during perioperative period had significant effects on wound infection, and the difference was statistically significant (P<0.05); the patient's own factors, the microenvironment of the preoperative incision and the surgical operation were not significant for the infection (P>0.05). In 226 cases, 11 cases (61.11%) of gram-positive bacteria were isolated from the pathogens of surgical site infection, 7 strains of gram-negative bacteria (38.89%), and 1 candida albicans infection. Gram-positive bacteria represented by staphylococcus aureus showed high drug resistance rate to penicillin and sulfamethoxazole/trimethoprim, and gram-negative bacteria represented by acinetobacter baumannii generally showed high drug resistance rate to ampicillin. Candida albicans was resistant to fluconazole and miconazole; the resistance rate of Candida albicans to miconazole was 100%, and the resistance rate to fluconazole, itraconazole, econazole and nystatin was 0.

Conclusion

The key to prevent incision infection after tension-free repair of inguinal hernia is to take effective preventive measures according to different risk factors and appropriate antibiotic should be adopted in postoperative infection period.

表2 行无张力补片修补术患者相关因素引起切口感染率间比较分析
表3 无张力修补术切口感染分离各类病原菌构成比分布情况[株(%)]
表4 革兰阳性菌对各类抗菌药物的耐药情况[株(%)]
表5 革兰阴性菌对各类抗菌药物的耐药情况[株(%)]
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