肝癌合并肝硬化患者肝切除术后腹腔内感染相关因素及病原菌耐药性分析

刘?娜; 李媛媛; 杨?豪; 许健东; 雷光林

文章摘要

肝癌合并肝硬化患者肝切除术后腹腔内感染相关因素及病原菌耐药性分析

Analysis of related factors of abdominal infection and drug resistance of pathogens after hepatectomy in patients with liver cancer and cirrhosis

DOI：10.3969/j.issn.1007-8134.2022.06.006

中文关键词: 肝癌合并肝硬化肝切除术腹腔内感染

英文关键词: Liver cancer and cirrhosis Hepatectomy Abdominal infection

基金项目:

作者	单位
刘?娜	解放军总医院第五医学中心核医学科
李媛媛	解放军总医院第五医学中心核医学科
杨?豪	解放军总医院第五医学中心肝病外科
许健东	江西省婺源中医院消化内科
雷光林	解放军总医院第五医学中心肝病外科

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中文摘要:

[摘要]?目的?分析肝癌合并肝硬化患者行肝切除术后发生腹腔内感染（intra-abdominal infection, IAI）相关危险因素、病原菌分布及其耐药性，为临床治疗提供参考。方法?收集我中心2018年1月—2021年1月收治的568例行肝切除的肝癌合并肝硬化患者的临床及微生物学相关资料。分析肝癌合并肝硬化患者行肝切除术后发生IAI的相关危险因素，并分析术后IAI的病原菌类型及药物敏感性情况。结果?单因素分析结果显示，年龄、术前白蛋白水平、糖尿病、术中第一肝门阻断时间、手术时间以及术前WBC水平是该类患者行肝切除术后发生IAI的主要影响因素（P均＜0.05）；Logistic多元回归模型分析结果显示，年龄≥60岁、合并糖尿病、手术时间≥120 min和术前WBC＜4×109/L为肝癌合并肝硬化患者行肝切除术后发生IAI的独立危险因素（P均＜0.05）。82例发生IAI患者腹腔引流液共培养出菌株138株，其中革兰阴性菌76株，革兰阳性菌62株，真菌0株。革兰阴性菌主要以大肠埃希菌为主，对美罗培南、亚胺培南和阿米卡星较为敏感，对氨苄西林、环丙沙星和左氧氟沙星耐药性较高；革兰阳性菌主要以肠球菌为主，对利奈唑胺、替加环素和万古霉素较为敏感，对克林霉素、红霉素以及莫西沙星耐药性较高。结论?年龄≥60岁、合并糖尿病、手术时间≥120 min和术前WBC＜4×109/L是肝癌合并肝硬化患者行肝切除术后发生IAI的危险因素。肝切除术后患者IAI的病原菌对部分抗生素敏感程度较高，临床治疗中须根据细菌培养结果和细菌特性合理用药，有利于患者预后。

英文摘要:

[Abstract]?Objective?To analyze the related risk factors, pathogen distribution and drug resistanceof intra-abdominalinfection (IAI) after hepatectomy in patients with liver cancer and cirrhosis,so as to provide reference for clinical treatment. Methods?Collect the clinical and microbiological data of 568 patients with liver cancer and cirrhosis treated in our center from January 2018 to January 2021 after hepatectomy. To analyze the related risk factors of IAI after hepatectomy, and the pathogen types and drug sensitivity of IAI after hepatectomy. Results?Univariate analysis showed that age, history of diabetes, preoperative albumin level, preoperative WBC level, operation time and the first hepatic portal occlusion time during operation were the main risk factors for IAI after hepatectomy (P＜0.05). Logistic multiple regression analysis results showed that age≥60 years, diabetes, preoperative WBC＜4×109/L and operation time≥120 min were independent risk factors for IAI after hepatectomy in patients with liver cancer and cirrhosis (P＜0.05). A total of 138 strains were cultured from the peritoneal drainage fluid of 82 patients with IAI, including 76 gram-negative bacteria, 62 gram-positive bacteria and 0 fungus. Gram-negative bacteria were mainly Escherichia coli, which was susceptible to meropenem, imipenem, and amikacin, and highly resistant to ampicillin, ciprofloxacin, and levofloxacin; Gram-positive bacteria were mainly enterococci, which was more susceptible to linezolid, tigecycline and vancomycin, and highly resistant to clindamycin, erythromycin, and moxifloxacin.Conclusions?Age ≥ 60 years old, complicated with diabetes, preoperative WBC＜4×109/L and operation time≥120 min were the risk factors for IAI in patients with liver cancer and cirrhosis after hepatectomy. The pathogenic bacteria of IAI after hepatectomy are highly sensitive to some antibiotics. In clinical treatment, rational drug use should be based on the results of bacterial culture and bacterial characteristics, which is conducive to the prognosis of patients.

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