{"title":"腹腔镜全子宫切除术后手术部位感染的相关因素","authors":"Kosuke Shigematsu, Koki Samejima, Yuichirou Kizaki, Shigetaka Matsunaga, Tomonori Nagai, Yasushi Takai","doi":"10.1016/j.lers.2022.09.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>In recent years, minimally invasive surgery has been emphasized in gynecological surgery, and total laparoscopic hysterectomy has been increasingly reported. In this retrospective single-center study, the main objective was to identify risk factors for the development of surgical-site infection (SSI) after total laparoscopic hysterectomy. The secondary objective was to investigate the efficacy of transvaginal drainage as a treatment for SSI.</p></div><div><h3>Methods</h3><p>This retrospective study investigated 377 patients who underwent total laparoscopic hysterectomy in the Department of Obstetrics and Gynecology at the Saitama Medical Center, Saitama Medical University, Japan between January 1, 2015 and December 31, 2019. Patients were divided into the SSI group and non-SSI group based on whether they suffered from SSI. The data of preoperative, intraoperative, and postoperative risk factors for SSI were collected and analyzed.</p></div><div><h3>Results</h3><p>Of the 377 patients who underwent total laparoscopic hysterectomy, 21 patients were in the SSI group and 356 patients were in the non-SSI group. After the comparison between the two groups and the multivariate analysis, only the C-reactive protein level on postoperative day 3 (OR = 1.556, 95% CI: 1.233–1.964, <em>p</em> < 0.001) showed a significant correlation with SSI. The receiver operating characteristic curve revealed that the C-reactive protein level >7.6 mg/dL on postoperative day 3 could detect the SSI onset early. In the SSI group, the hospital stay was longer for patients with transvaginal drainage than for patients without (17.40 ± 3.21 d vs. 10.90 ± 2.39 d, <em>p</em> = 0.0027). However, none required reoperation.</p></div><div><h3>Conclusions</h3><p>Patients with a high postoperative C-reactive protein level may be experiencing SSI, and ultrasonography and other imaging procedures should be performed immediately. If a vaginal abscess is confirmed on imaging, transvaginal drainage should be performed early, which may prevent reoperation.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"5 4","pages":"Pages 131-135"},"PeriodicalIF":0.0000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246890092200069X/pdfft?md5=63e384bfb37188942de5d4d44a87e6a1&pid=1-s2.0-S246890092200069X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Factors associated with surgical-site infection after total laparoscopic hysterectomy\",\"authors\":\"Kosuke Shigematsu, Koki Samejima, Yuichirou Kizaki, Shigetaka Matsunaga, Tomonori Nagai, Yasushi Takai\",\"doi\":\"10.1016/j.lers.2022.09.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>In recent years, minimally invasive surgery has been emphasized in gynecological surgery, and total laparoscopic hysterectomy has been increasingly reported. In this retrospective single-center study, the main objective was to identify risk factors for the development of surgical-site infection (SSI) after total laparoscopic hysterectomy. The secondary objective was to investigate the efficacy of transvaginal drainage as a treatment for SSI.</p></div><div><h3>Methods</h3><p>This retrospective study investigated 377 patients who underwent total laparoscopic hysterectomy in the Department of Obstetrics and Gynecology at the Saitama Medical Center, Saitama Medical University, Japan between January 1, 2015 and December 31, 2019. Patients were divided into the SSI group and non-SSI group based on whether they suffered from SSI. The data of preoperative, intraoperative, and postoperative risk factors for SSI were collected and analyzed.</p></div><div><h3>Results</h3><p>Of the 377 patients who underwent total laparoscopic hysterectomy, 21 patients were in the SSI group and 356 patients were in the non-SSI group. After the comparison between the two groups and the multivariate analysis, only the C-reactive protein level on postoperative day 3 (OR = 1.556, 95% CI: 1.233–1.964, <em>p</em> < 0.001) showed a significant correlation with SSI. The receiver operating characteristic curve revealed that the C-reactive protein level >7.6 mg/dL on postoperative day 3 could detect the SSI onset early. In the SSI group, the hospital stay was longer for patients with transvaginal drainage than for patients without (17.40 ± 3.21 d vs. 10.90 ± 2.39 d, <em>p</em> = 0.0027). However, none required reoperation.</p></div><div><h3>Conclusions</h3><p>Patients with a high postoperative C-reactive protein level may be experiencing SSI, and ultrasonography and other imaging procedures should be performed immediately. If a vaginal abscess is confirmed on imaging, transvaginal drainage should be performed early, which may prevent reoperation.</p></div>\",\"PeriodicalId\":32893,\"journal\":{\"name\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"volume\":\"5 4\",\"pages\":\"Pages 131-135\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S246890092200069X/pdfft?md5=63e384bfb37188942de5d4d44a87e6a1&pid=1-s2.0-S246890092200069X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S246890092200069X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laparoscopic Endoscopic and Robotic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S246890092200069X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的近年来，微创手术在妇科手术中受到重视，腹腔镜全子宫切除术的报道越来越多。在这项回顾性单中心研究中，主要目的是确定腹腔镜子宫全切除术后手术部位感染(SSI)发生的危险因素。次要目的是研究经阴道引流治疗SSI的疗效。方法回顾性研究2015年1月1日至2019年12月31日在日本埼玉医科大学埼玉医学中心妇产科行腹腔镜全子宫切除术的377例患者。根据患者是否有自残，将患者分为自残组和非自残组。收集术前、术中、术后SSI危险因素数据并进行分析。结果377例腹腔镜全子宫切除术患者中，SSI组21例，非SSI组356例。经两组比较及多因素分析，仅术后第3天c反应蛋白水平差异(OR = 1.556, 95% CI: 1.233-1.964, p <0.001)与SSI有显著相关性。患者工作特征曲线显示术后第3天c反应蛋白水平>7.6 mg/dL可早期检测SSI的发生。在SSI组中，经阴道引流患者的住院时间比不经阴道引流的患者长(17.40±3.21 d比10.90±2.39 d, p = 0.0027)。然而，没有人需要再次手术。结论术后c反应蛋白水平高的患者可能出现SSI，应立即行超声等影像学检查。如果影像学证实阴道脓肿，应尽早经阴道引流，避免再次手术。
Factors associated with surgical-site infection after total laparoscopic hysterectomy
Objective
In recent years, minimally invasive surgery has been emphasized in gynecological surgery, and total laparoscopic hysterectomy has been increasingly reported. In this retrospective single-center study, the main objective was to identify risk factors for the development of surgical-site infection (SSI) after total laparoscopic hysterectomy. The secondary objective was to investigate the efficacy of transvaginal drainage as a treatment for SSI.
Methods
This retrospective study investigated 377 patients who underwent total laparoscopic hysterectomy in the Department of Obstetrics and Gynecology at the Saitama Medical Center, Saitama Medical University, Japan between January 1, 2015 and December 31, 2019. Patients were divided into the SSI group and non-SSI group based on whether they suffered from SSI. The data of preoperative, intraoperative, and postoperative risk factors for SSI were collected and analyzed.
Results
Of the 377 patients who underwent total laparoscopic hysterectomy, 21 patients were in the SSI group and 356 patients were in the non-SSI group. After the comparison between the two groups and the multivariate analysis, only the C-reactive protein level on postoperative day 3 (OR = 1.556, 95% CI: 1.233–1.964, p < 0.001) showed a significant correlation with SSI. The receiver operating characteristic curve revealed that the C-reactive protein level >7.6 mg/dL on postoperative day 3 could detect the SSI onset early. In the SSI group, the hospital stay was longer for patients with transvaginal drainage than for patients without (17.40 ± 3.21 d vs. 10.90 ± 2.39 d, p = 0.0027). However, none required reoperation.
Conclusions
Patients with a high postoperative C-reactive protein level may be experiencing SSI, and ultrasonography and other imaging procedures should be performed immediately. If a vaginal abscess is confirmed on imaging, transvaginal drainage should be performed early, which may prevent reoperation.
期刊介绍：
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.
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