目的: 探讨两种肠道准备方式对胃肠道恶性肿瘤术后手术部位感染(Surgical site infection,SSI)的影响。方法: 将238例胃肠道恶性肿瘤患者术前随机分为两组,分别为机械性肠道准备组(Mechanical bowel preparation MBP)和联合组,联合组在MBP组基础上联合口服抗生素肠道准备(Antibiotic bowel preparation,ABP),比较两组间SSI发生率的差异;术后将患者根据SSI诊断标准分为SSI组及非SSI组,围手术期监测白细胞(White blood cell,WBC) 、白蛋白(Albumin,Alb)、降钙素原(Prcoalcitonin,PCT) 、C-反应蛋白(C-reactive protein,CRP)等水平,分析两组间各血液指标对SSI的预测作用,并筛选出发生SSI的危险因素。结果: 联合组SSI发生率低于MBP组(χ²=12.472,P＜0.001)。由重复测量方差结果可得两组间PCT水平整体间差异有统计学意义(F=42.983,P＜0.001),且术后第1、3、5 d时间点SSI组显著高于非SSI组。两组间CRP水平整体间差异有统计学意义(F=18.280,P＜0.001),且术后第3、5 d时间点SSI组显著高于非SSI组。ROC曲线中术后第5 d PCT曲线下面积0.942,当取截点为1.075 μg/L时,诊断SSI的敏感度为0.917,特异度为0.878;logistic回归分析显示:术前联合ABP、术后第5 dPCT水平与术后SSI之间存在显著相关性(P＜0.05),且术后第5 d PCT水平是影响发生SSI的独立危险因素,术前口服抗生素是SSI的独立保护因素。结论: MBP联合ABP可显著降低胃肠道恶性肿瘤术后SSI发生率,术后规律复查PCT可更早地预测SSI的发生,对术后SSI的发生起到了早期预警作用,有利于指导临床早期对SSI的处理。

Objective: To investigate the effects of two different bowel preparation methods on postoperative surgical site infection (SSI) of gastrointestinal malignant tumors. Methods: A total of 238 patients with gastrointestinal malignancies were randomly divided into two groups preoperatively: mechanical bowel preparation MBP group and oral antibiotic bowel preparation (ABP) combined MBP group (combination group), and the difference in SSI incidence between the two groups was analyzed. Postoperatively, the patients were divided into SSI and non SSI groups according to the diagnostic criteria of SSI, and the levels of white blood cell (WBC), albumin (ALB), procalcitonin (PCT), and C-reactive protein (CRP) were monitored perioperatively to analyze the predictive effect of each blood indicator on SSI and to screen the risk factors for developing SSI. Results: The incidence of SSI in combination group was lower than that in MBP group (χ²=12.472, P=0.000). According to the results of repeated measurement variance, the overall difference of PCT level between the two groups was statistically significant (F=42.983, P=0.000), and the SSI group was significantly higher than the non-SSI group at the 1st, 3rd and 5th day after surgery. The overall difference of CRP level between the two groups was statistically significant (F=18.280, P=0.000), and the SSI group was significantly higher than the non-SSI group at 3 and 5 days after operation. In the ROC curve, the area under the PCT curve on the 5th day after operation was 0.942, and when the cut-off point was 1.075 μg/L, the sensitivity and specificity of SSI diagnosis were 0.917 and 0.878 respectively. Logistic regression analysis showed that there was a significant correlation between preoperative ABP, PCT level on the 5th day after surgery and postoperative SSI (P＜0.05), and PCT level on the 5th day after surgery was an independent risk factor for SSI , and preoperative oral antibiotics was an independent protective factor for SSI . Conclusions: MBP combined with ABP can significantly reduce the incidence of postoperative SSI in patients with gastrointestinal malignancies. PCT can predict the occurrence of SSI earlier, and play an early warning role in the occurrence of postoperative SSI, which is conducive to guiding the early clinical treatment of SSI.