ミニマム創・内視鏡下泌尿器手術における手術部位感染の臨床的検討

Abstract

2000年4月～2001年12月までの間に施行したミニマム創・内視鏡下手術144例を検討対象とした.手術創の清潔度はAmerican College of Surgeonの分類に準じた.尿路を開放しない術式を清潔手術, 開放する術式を準清潔手術とした.ミニマム創・内視鏡下手術における手術部位感染(SSI)の頻度および危険因子を検討した.清潔手術ではSSIは発生しなかった.SSIの危険因子は術前低アルブミン血症(3.6g/dl未満), 腸管利用手術であった.膀胱全摘・回腸導管造設術のSSIの要因として, 消化管由来の内因性細菌の感染も認められ, 下部消化管手術に準じた抗生物質の術前投与の必要性が示唆された

We investigated the clinical risk factors and bacteriological examination for surgical site infection (SSI) in 144 portless endoscopic surgeries consisting of 66 clean and 78 clean-contaminated surgeries in urological diseases from April 2000 to December 2001. There were no cases of SSI in the clean surgeries. SSI occurred in 5 cases (3.5%) of clean-contaminated surgeries including total cystectomy and ileal conduit in 4 cases and total prostatectomy in 1 case. Multivariate statistical studies revealed that usage of ileum during operation and preoperative hypo-albuminemia were significant risk factors for SSI. Gram-negative rods and anaerobic bacteria were isolated from the operative wound in the total cystectomy and ileal conduit, suggesting that SSI in the operation with usage of the ileum was partially derived from contamination with endogenous bacteria, while, normal flora of the skin in the wound did not cause any post-operative SSI.