根治的膀胱全摘除術における手術部位感染の危険因子に関する検討 : 吸収糸による皮膚埋没縫合の有用性

Abstract

We assessed the incidence, risk factors and causative organism for surgical site infection (SSI). We reviewed the clinical charts of the consecutive 100 patients who underwent radical cystectomy from December 2003 to April 2008. All patients received intravenous prophylactic antimicrobial agent, 1 gram of cefotium hydrochloride before surgery followed by the same agent twice a day through postoperative day 3. Skin closures were carried out by interrupted sutures employing a 3-0 nylon for the first 50 patients (interrupted group), and by buried suture employing 3-0 or 4-0 braided polyglactin for the last 50 patients (buried group). SSI occurred in 13 cases (26%) with interrupted group including 8 patients with ureterocutaneoustomy and 5 patients with orthotopic ileal neobladder reconstruction. On the other hand, SSI was found in 1 patient (2%) in the buried group for whom ileal neobladder reconstruction was carried out (P= 0.021). Superficial inflectional SSI was found in 6 patients (5 patients in the interrupted group, patient in the buried group) and deep incisional SSI occurred in 5 patients in the interrupted group only. The most frequently isolated organism was Enterococcus faecalis. Univariate analysis revealed that body mass index (BMI) and the skin closure methods were significant risk factors for SSI (P<0.001, P=0.021, respectively). These 2 risk factors for SSI were also significant in multivariate analysis (P=0.003, P=0.037, respectively). These results suggested that BMI and the skin closure methods are independent risk factors in radical cystectomy. Furthermore, it may be possible to reduce the incidence of SSI by performing the buried suture for the skin closure.

2003年12月-2008年4月に実施した根治的膀胱全摘徐術症例100例を対象にSSI(手術部位感染)の危険因子について検討し、吸収糸による皮膚埋没縫合の有用性について検証した。皮膚縫合法として2003年12月-2005年11月の50例はナイロン糸による結節縫合を行い(結節群)、2005 年12月-2008年4月の50例は吸収糸で真皮層を連続縫合する埋没縫合術(埋没群)を行った。両群の比較では、埋没群に膿尿が多く、結節群に腸管利用尿路変更術が多く、術前化学療法の施行症例は少ない傾向にあったが有意差は認めなかった。結節群に女性は少なく、BMIが高く手術時間が長かった。単変量解析ではBMIおよび縫合法の種類がSSIの有意な危険因子であり、多変量解析においてもこの2因子はSSIの発生における独立因子であった。SSI発生率は14%に認め、埋没群は2%で結節群に比し有意に低率で、感染部位も表層切開部SSIのみで尿路変更術の有無によるSSI発生頻度に差は認めなかった。根治的膀胱全摘除術後のSSIの危険因子としてBMIと皮膚縫合法の相違は独立した危険因子として同定された。吸収糸による埋没縫合により術後SSI 発生リスクの軽減の可能性が示唆されたと考えた。