Analysis Of Bacterial Culture Of Abdominal Drainage Fluid After Total Laparoscopy And Laparoscopic-Assisted And Open Surgery For Gastric Cancer

Objective:To investigate the clinical value of bacteria culture in abdominal drainage fluid after total laparoscopy,laparoscopic assisted surgery and open surgery for gastric cancer.Methods:Clinical data of 171 patients who received surgical treatment for gastric cancer in the gastrointestinal surgery department of our hospital from March 2015 to December 2021 and met the criteria of this study were retrospectively collected,and they were divided into total laparoscopic group,laparoscopic-assisted group and laparotomy group according to surgical methods.The intraoperative data,clinicopathological factors,bacterial culture results and postoperative complications of the three groups were statistically analyzed and compared.Results: In this study,171 patients were divided into three groups according to surgical methods,including 48 in the OG group,45 in the TLG group,and 78 in the LAG group.The clinical data of all patients were statistically analyzed and processed,and the results were as follows:(1)Preoperative general data: There were no statistically significant differences in male and female composition ratio,age,BMI,whether there was neoadjuvant chemotherapy or not,and whether there were underlying diseases before surgery among the three groups(P > 0.05).(2)Clinicopathological factors: there were no statistical differences in pathological typing,tumor differentiation and TNM stage among the three groups(P > 0.05);(3)Intraoperative conditions: there was no statistical difference in resection methods among the three groups(P > 0.05);There were significant differences in the number of lymph node dissection,operation duration and abdominal incision length(P <0.01).There were significant differences in intraoperative blood loss(P < 0.01),among which,there were significant differences between the OG group and the TLG and LAG groups(P < 0.01),and no significant differences between the TLG and LAG groups(P > 0.05).(4)Postoperative conditions: Postoperative hospitalization days: there were statistical differences among the three groups(P < 0.01),among which there were statistical differences between the OG group and THE LAG and TLG group(P < 0.01),and no statistical differences between the TLG group and the LAG group(P >0.05).Postoperative ventilation time: there were statistically significant differences among the three groups(P < 0.01),among which there were statistically significant differences between the OG group and the TLG and LAG group(P < 0.01),but there were no statistically significant differences between the TLG and LAG group(P >0.05).(5)Bacterial culture results of drainage fluid: there was no statistical difference in the positive rate of patients in the three groups on the 1st,3rd and 5th day after surgery(P > 0.05);(6)Postoperative complications: there were statistical differences among the three groups(P < 0.05);(7)The relationship between positive bacteria culture and anastomotic leakage: data were regrouped into anastomotic leakage group and non-anastomotic leakage group.The positive rate of bacteria culture after operation showed no statistical difference on the first day(P > 0.05),but there was a difference on the third and fifth days(P < 0.01).Postoperative CRP: there was no statistical difference on the 1st day,but there was difference on the 3rd and 5th days(P < 0.01).(8)Risk factors of anastomotic leakage: in univariate analysis,preoperative hemoglobin(< 90g/L),preoperative albumin(< 35g/L),the number of neoadjuvant chemotherapy,total gastric surgery and lymph node metastasis > 7 were related to anastomotic leakage(P < 0.05).In logistic regression multivariate analysis,preoperative albumin < 35g/L,preoperative hemoglobin < 90g/L and neoadjuvant chemotherapy were independent risk factors(P < 0.05).Conclusion: 1.There was no significant difference in the bacterial culture of postoperative drainage fluid between the three groups,and laparoscopic surgery did not increase the risk of postoperative anastomotic leakage and abdominal infection,indicating that laparoscopic surgery was safe and feasible.2.Positive bacterial culture of drainage fluid 3 and 5 days after surgery and increased C-reactive protein 3 and 5days after surgery(CRP > 153.5μg/L on the 3rd day and > 165μg/L on the 5th day)have high diagnostic value for postoperative anastomotic leakage.3.The most common strains of abdominal infection were Enterobacteria,mainly composed of Escherichia coli and Klebsiella pneumoniae,while enterococcus was the most common grampositive strains,mainly composed of Enterococcus faecalis and Enterococcus faecium.4.Preoperative hemoglobin and albumin levels,neoadjuvant chemotherapy or not,resection method and number of lymph node metastasis were risk factors for anastomotic leakage,among which preoperative albumin < 35g/L,preoperative hemoglobin < 90g/L and neoadjuvant chemotherapy were independent risk factors.