大腸癌手術症例におけるsurgical site infection (SSI)に及ぼす因子の検討とSSI予防の取り組み | Examination of Surgical Site Infection(SSI)Outbreak Factor in Colo-rectal Cancer Surgery and Effect of Anti-SSI Measures

〔原著〕

大腸癌手術症例におけるsurgical site infection (SSI)に
及ぼす因子の検討とSSI予防の取り組み

神崎　憲雄，石井　俊一，鈴木　正明

かしま病院外科

（受付2008年9月16日　受理2008年11月4日）

Examination of Surgical Site Infection(SSI)Outbreak Factor in Colo-rectal Cancer Surgery and Effect of Anti-SSI Measures

NORIO KANZAKI, SHUNICHI ISHII and MASAAKI SUZUKI

Department of surgery, Kashima Hospital, Fukushima, Japan

要旨 : 消化器外科手術，特に結腸・直腸手術において手術部位感染 (SSI) の発生頻度は高く，医療コストや在院日数の増加につながり，診療上さまざまな不利益をもたらす。今回大腸癌手術症例のSSI発生に及ぼす因子の検討と，当院のSSI予防の取り組みとその効果について報告する。対象は2003年10月から2008年9月までに行った，大腸切除術症例72例。結果，SSIは72例中12例（16.7%）に発生した。SSIの発生因子として，単変量解析の結果，性別，出血量，人工肛門造設の有無，術前の総リンパ球数，SSI対策の有無が有意であり，多変量解析の結果，性別（男性)，術前の総リンパ球数が有意であり，SSI発生に術前の栄養状態や免疫機能が係わる可能が示唆された。SSI対策として2006年8月より創縁保護具を用い，閉創時創部を洗浄するなどを行った。またSSI対策を行った結果，対策前32例中9例（28.1%）の発生率に対し，SSI対策後は40例中3例（7.5%）と有意(p=0.0196)にSSI発生率は低下し，SSI発生軽減に創縁保護具の使用や閉創時の工夫などが奏功した。さらにSSI対策を施した一部の症例に対して術前Immunonutritionを実施した結果，非実施群24例中2例（8.3%）の発生率に対し，実施群16例中1例（6.3%）と有意差は認められなかったが，今後のSSI対策として注目すべきと思われた。

索引用語: 手術部位感染，大腸癌,手術，発生因子，SSI対策

Abstract: We report factors associated with the onset of SSI among patients undergoing surgery for colorectal cancer in addition to the types and effectiveness of measures for preventing SSI at our hospital. Subjects were 72 patients who had undergone colon resection between September 2003 and July 2008. SSI occurred in 12 (16.7%) of these patients.
Based on univariate analysis, the following factors were identified as being significantly associated with SSI: sex, blood loss, colostomy, preoperative total lymphocyte count, and presence or absence of SSI measures. In addition, multivariate analysis for these factors showed significant effects for sex and preoperative total lymphocyte count. These findings suggest that preoperative nutritional status and immune function are related to SSI.
Measures for SSI, such as washing of the closed surgical site using a wound retractor, were implemented in August 2006. The incidence of SSI significantly decreased (p=0.0196) from 28.1% (9 of 32 patients) before implementation of these measures to 7.5% (3 of 40 patients) after implementation. In addition, although preoperative immunonutrition was given to some patients following implementation of SSI measures, no significant differences in incidence of SSI were observed between patients receiving immunonutrition (1/16; 6.3%) and those not receiving immunonutrition (2/24; 8.3%). Further consideration of immunonutrition as a measure for SSI may be necessary.

Key words: surgical site infection (SSI), colo-rectal cancer, surgery, outbreak factor, anti-SSI measures