探讨妇科恶性肿瘤患者术后感染影响因素。

选择2020年4月至2023年3月于重庆大学附属人民医院妇科进行手术治疗的234例妇科恶性肿瘤患者为研究对象。其中，宫颈癌患者为80例，卵巢癌为107例，子宫内膜癌为47例。根据患者术后是否发生感染，将其分别纳入感染组(n＝55)与非感染组(n＝179)。采用回顾性分析方法，收集2组患者一般临床资料及术前、术中与术后相关临床资料，并分别采用成组t检验、χ²检验进行统计学分析。采用多因素非条件logistic回归分析法，对妇科肿瘤患者术后感染的独立影响因素进行分析。2组患者年龄、人体质量指数(BMI)等一般临床资料比较，差异均无统计学意义(P>0.05)。本研究遵循的程序通过重庆大学附属人民医院医学伦理委员会批准(批准文号：KYS2022-012-01)。

①本研究感染组55例发生术后感染患者阴道分泌物细菌培养结果显示，60株菌株中，大肠埃希菌占比最高(32/55，58.2%)，其次为铜绿假单胞菌感染(4/55，9.1%)，阴沟肠杆菌阴沟亚种(4/55，7.3%)及肺炎克雷伯菌(4/55，7.3%)；8例(14.5%)患者为双重细菌感染。②2组患者肿瘤类型、美国麻醉医师协会(ASA)分级、手术时长、阴道断端缝线种类、使用引流管、引流管留置位置、引流管留置时间、尿管插管次数、尿管留置时间、中心静脉插管≥1次、中心静脉插管时间、术后使用抗菌药物类型和抗菌药物使用时间等13个因素分别比较，差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析结果显示，ASA分级为Ⅲ＋Ⅳ级、阴道断端缝线为普通荞缝线，均为妇科肿瘤患者术后感染的独立危险因素(OR＝3.266、3.632，95%CI：1.361~7.645、1.454~9.072，P＝0.008、0.006)；相对于术后单用头孢类抗菌药物治疗，术后使用非头孢类抗菌药物为妇科恶性肿瘤患者术后感染的独立保护因素(OR＝0.298，95%CI：0.127~0.702，P＝0.006)；相对于术后抗菌药物使用1~3 d，术后抗菌药物使用4~7 d与≥8 d，亦均为妇科恶性肿瘤患者术后感染的独立保护因素(OR＝0.103、0.073，95%CI：0.031~0.340、0.019~0.277，均为P<0.001)。

ASA分级、阴道断端缝线类型、术后使用抗菌药物类型和术后抗菌药物使用时间，均为妇科恶性肿瘤患者术后感染的独立影响因素。术前积极营养支持，术中合理选择抗菌缝线，以及术后合理使用抗菌药物与足量、足疗程抗菌药物治疗等，将有助于降低妇科恶性肿瘤患者术后感染风险。

To explore the influencing factors of postoperative infection in patients with gynecological malignant tumors.

A total of 234 patients with gynecological malignancies who underwent surgical treatment at the Department of Gynecology, Chongqing General Hospital, Chongqing University from April 2020 to March 2023 were selected as the study subjects. Among them, 80 cases were cervical cancer, 107 cases were ovarian cancer, and 47 cases were endometrial cancer. Patients were divided into infection group (n=55) and non-infection group (n=179) based on whether they developed postoperative infection. A retrospective analysis was conducted to collect general clinical data and preoperative, surgical, and postoperative data from both groups, and comparative analyses were performed using independent-samples t test and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of postoperative infection in gynecological malignant tumor patients. There were no statistically significant differences in age, body mass index (BMI), or other general clinical data between two groups (P>0.05). The procedures followed in this study were approved by the Medical Ethics Committee of Chongqing General Hospital, Chongqing University (Approval No. KYS2022-012-01).

①Among 234 patients with gynecological malignancies, 55 cases (23.5%) developed postoperative infections. Of the 55 infected patients, 60 strains of pathogens were cultured, with Escherichia coli having the highest incidence (32/55, 58.2%), followed by Pseudomonas aeruginosa (5/55, 9.1%), Enterobacter cloacae subsp. cloacae (4/55, 7.3%), and Klebsiella pneumoniae (4/55, 7.3%); 8 cases (14.5%) had dual bacterial infections. ②Univariate analysis revealed that there were statistically significant differences between two groups in 13 factors, including tumor type, American Society of Anesthesiologists (ASA) classification, operation duration, type of vaginal stump suture, use of drainage tube, drainage tube placement location, duration of indwelling drainage tube, number of urinary catheter insertions, duration of indwelling urinary catheter, ≥1 central venous catheterization, duration of central venous catheterization, types of postoperative use of antibiotics, and duration of antibiotic use (P<0.05). ③Multivariate unconditional logistic regression analysis showed that ASA classification Ⅲ+ Ⅳ and conventional suture for vaginal stump closure were independent risk factors for postoperative infection in patients with gynecological tumors (OR=3.266, 3.632, 95%CI: 1.361-7.645, 1.454-9.072, P=0.008, 0.006). Compared to postoperative cephalosporin antibiotics alone, postoperative use of non-cephalosporin antibiotics was an independent protective factor against postoperative infection in patients with gynecological malignancies (OR=0.298, 95%CI: 0.127-0.702, P=0.006). Compared to postoperative antibiotic use for 1-3 days, postoperative antibiotic use for 4-7 days and ≥8 days were also independent protective factors against postoperative infection in patients with gynecological malignancies (OR=0.103, 0.073, 95%CI: 0.031-0.340, 0.019-0.277, both P<0.001).

ASA classification, vaginal suture type, type of postoperative antibiotics used, and duration of postoperative antibiotic use are all independent influencing factors for postoperative infection in patients with gynecological malignancies. Postoperative nutritional intervention, intraoperative antimicrobial suture utilization, proper postoperative use of antibiotics and standardized postoperative antibiotic protocols may effectively reduce the risk of postoperative infection in patients with gynecological malignancies.