[National Cancer Prevention and Treatment Week] How to prevent and treat these 5 common infections after colorectal cancer surgery? This article will teach you!

It is reported that despite strict aseptic measures during surgery, the incidence of postoperative infection after colorectal cancer surgery is still as high as 5~40% [1].

Common infections after colorectal cancer surgery include surgical incision infection , abdominal infection , lung infection (pneumonia), urinary tract infection , and deep vein catheter infection . Once a colorectal cancer patient develops an infection after surgery, it will not only increase the patient's pain, but also prolong the postoperative recovery time, increase the number of hospitalization days and medical expenses, and affect subsequent treatment. Severely infected patients may require a second hospitalization or a second surgery, or even lead to death. Therefore, understanding the relevant knowledge about postoperative infection of colorectal cancer can help us take effective measures in advance, achieve early diagnosis and early treatment, and minimize the harm of infection.

<Q>Why is incision infection more likely to occur after colorectal cancer surgery? How can it be prevented and treated?

Surgical wound infection is the most common complication after colorectal cancer surgery. Literature reports that the incidence of surgical wound infection after colorectal cancer surgery is as high as 5.9% to 24% [2].

(1) Inadequate bowel preparation

The colon is the largest bacterial reservoir in the human body. Inadequate intestinal preparation before surgery leads to incomplete excretion of stool in the intestine. Cutting the intestine during surgery can easily cause intestinal contents to overflow, leading to surgical incision infection and abdominal cavity infection. Even if the patient takes laxatives regularly before surgery to empty the solid feces in the intestine, there will still be a lot of fecal water left in the intestine during surgery.

(2) Surgical factors

During surgery, the intestines need to be cut, reconnected, and anastomosed, and contamination of the abdominal cavity and surgical incision may still occur during this process. Especially when the tumor is large, the surgical scope is large, and the operation time is long, the probability of contamination and various infections is higher.

(3) Personal conditions and postoperative care factors

Incisional infection is related to the patient's own condition and postoperative incision care. The elderly, those with diabetes, preoperative malnutrition, preoperative intestinal obstruction and obesity are more likely to develop incisional infection. Obese people have more abdominal fat, and fat liquefaction is prone to occur in the incision after surgery. If it is not properly handled in time, bacterial infection is prone to occur, leading to incisional infection and poor healing. Incisional infection may initially be only incisional fat liquefaction or incisional hematoma, and then gradually progress to incisional infection, leading to serious consequences such as poor incisional healing, incisional dehiscence and incisional hernia. Incisional infection can cause delays in patients' postoperative chemotherapy and radiotherapy, thereby affecting the patient's survival time.

Precautions:

(1) Strengthen nutritional support therapy: After surgery, according to the doctor's instructions, eat more high-protein foods, such as steamed eggs, fish, chicken, minced meat and protein powder.

(2) Actively control blood sugar: For patients with diabetes, blood sugar changes should be monitored before and after surgery. Oral hypoglycemic drugs and subcutaneous insulin injections should be used in a standardized manner according to blood sugar levels to control blood sugar.

(3) Follow the doctor's instructions and change the dressing regularly (disinfect the wound and replace the gauze on the surface of the incision). Pay attention to the wound condition. If you find that the wound exudates a lot and the gauze on the surface of the wound is completely wet, you should contact the doctor in time to clean the wound and replace the gauze.

(4) For patients with long incisions or incision infection, special attention should be paid to the use of medical elastic abdominal belts or multi-head abdominal belts after surgery, which can reduce the tension of the abdominal incision and reduce the risk of incision dehiscence.

(5) When the patient coughs, the abdominal cavity pressure is high, which can easily stretch the wound. It is recommended that when the patient coughs, the patient or family members can use both hands to gently push from both sides of the abdomen to the middle to reduce the tension on the abdominal wound and avoid wound rupture.

<Q> Why is lung infection (pneumonia) more likely to occur after colorectal cancer surgery? How can it be prevented and treated?

The incidence of pneumonia after colorectal cancer surgery is 1.5-15.3% [3]. Most patients require endotracheal intubation during surgery, which can easily cause the respiratory tract to secrete a lot of sputum. In addition, the placement of a gastric tube can also make it difficult to cough up sputum. The pain from the abdominal incision after surgery also makes many patients afraid or unwilling to cough and expectorate. When sputum accumulates in the lungs and cannot be discharged, it can cause lung inflammation. In particular, elderly patients with a history of lung diseases (such as chronic bronchitis, emphysema) and long-term smokers are more likely to develop pneumonia after surgery.

Precautions:

(1) Quit smoking before and after surgery.

(2) Perform cough training and respiratory function exercises before surgery.

The specific method is as follows:

① Deep breathing exercise: take a deep breath, then exhale slowly, 10 to 15 times each time, 3 times a day;

②Balloon blowing exercise: Take a deep breath, hold your breath and slowly blow into the balloon, 10 to 15 minutes a day, 3 times a day;

③ Coughing exercise: take a deep breath, hold your breath for a short time, and use your abdomen to cough hard to push out the air;

(3) Early coughing and expectoration are encouraged after surgery.

If the sputum is too dry to cough out, drink 1-2 sips of water to moisten your throat, and then cough hard to make it easier to cough out. In addition, in order to reduce the pain of the abdominal incision caused by coughing and avoid the incision from splitting, pay attention to protecting the incision with both hands when coughing.

(4) Turn the patient over and pat his back frequently after surgery.

It is recommended that the patient lie on the left side, right side, or supine for 5 minutes each, alternating repeatedly. When patting the back, the patient can sit or lie on the side, with the family member's palm cupped, four fingers together and slightly bent, and the thumb close to the other four fingers (Figure 1).

Figure 1 : The pat on the back gesture

Keep your wrists still, use your shoulders and elbows to move your palms, and pat your back with your palms. Generally, do this 40 to 50 times per minute, and pay attention to even strength. Tap from bottom to top, from outside to inside (Figure 2). Do this for 10 to 15 minutes each time. Do not pat your back with the palm or base of your palm.

Figure 2 The order of back patting

(5) Early bed rest and activity are encouraged after surgery to help cough up sputum and reduce the incidence of pneumonia.

(6) Report any cough or sputum to the doctor promptly. The doctor will prescribe expectorant drugs, such as oral compound licorice mixture, Qutanling oral liquid, snake gallbladder, Chuanbei loquat paste, ambroxol injection, and nebulizer inhalation, depending on the situation.

<Question>How to prevent abdominal infection after colorectal cancer surgery?

The incidence of abdominal infection after colorectal cancer surgery is as high as 11-26%, which is the most serious infectious complication [3]. Common abdominal infections after colorectal cancer surgery include anastomotic leakage and abdominal abscess, which usually require interventional treatment (peritoneal puncture and catheter drainage) or even secondary surgery. The main risk factors for abdominal infection include long-term smoking, obesity, diabetes, malnutrition and long-term bed rest. Early diagnosis of abdominal infection can allow early intervention and prevent it from progressing to more serious systemic infection.

Precautions:

(1) Strengthen nutritional support therapy;

(2) Actively control blood sugar;

(3) Semi-recumbent position and getting out of bed to move around more often can help absorb the fluid and blood in the abdominal cavity and reduce the incidence of abdominal infection;

(4) Quitting smoking at least 2 weeks before surgery can reduce the incidence of infection;

(5) Pay attention to protecting the abdominal drainage tube to prevent it from slipping off. If the drainage tube slips off, the blood and fluid accumulated in the abdominal cavity cannot be discharged, which will increase the chance of infection.

<Q>How to prevent urinary tract infection after colorectal cancer surgery?

Urinary tract infection after colorectal cancer surgery is more likely to occur in patients with long-term indwelling catheters, repeated catheter insertions, and those with prostatic hypertrophy. During rectal cancer surgery, there is a risk of damaging the nerves that control urination, leading to urinary dysfunction after surgery, and thus increasing the chance of urinary tract infection.

Precautions:

(1) Clean the dirt around the urethral opening and catheter promptly after surgery.

(2) Before removing the catheter, follow the doctor's instructions to intermittently clamp the catheter to train bladder function. The method of clamping the catheter is: clamp the catheter completely to prevent urine from flowing out. When the patient feels like urinating, release the catheter for 5 minutes, then clamp the catheter again, and repeat this cycle. If the patient does not feel like urinating, open the catheter every 2 to 3 hours. Note that the catheter should not be clamped when sleeping at night.

(3) Take medications that aid urination as prescribed by your doctor, such as tamsulosin hydrochloride sustained-release capsules and finasteride tablets.

(4) Leaving the catheter in place for too long will increase the chance of infection, so the catheter must be removed promptly after surgery as directed by the doctor.

<Question>How to prevent central venous catheter infection after colorectal cancer surgery?

If the central venous catheter is left in place for too long after colorectal cancer surgery, catheter infection is likely to occur, which is often manifested as a sudden onset of fever about one week after surgery, sometimes accompanied by redness and swelling at the puncture site.

Precautions:

(1) Do not touch or scratch the skin at the catheter puncture site.

(2) Keep the skin around the catheter clean. If the film on the catheter surface is not firmly attached due to sweating, contact the nurse immediately to replace the film.

(3) The central venous catheter should not be left in place for too long. It should be removed about one week after surgery, following the instructions of medical staff.

【References】

1. Liu Zongrong, Zhu Yifan, Ma Cong, Gong Yingsheng. Investigation and analysis of infectious complications after colorectal cancer surgery[J]. Chinese Journal of General Surgery, 2008, 17(1): 104-106.

2. Peng Xingang, Gao Junru, Luo Wenqiang, Wang Peige. Analysis of related factors of surgical wound infection in colon cancer[J]. Surgery, 2021, 10(2): 14-19.

3. Yan Yulu, Cui Xiaoguang. Risk factors and prevention of postoperative infection in patients with colorectal cancer[J]. Chinese Electronic Journal of Colorectal Diseases, 2018, 7(2): 181-184.

Editor: Liu Yang and Zhao Na

Proofread by Li Na and Li Yule

Producer: Peng Bin

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