目的：分析甲状腺疾病患者行达芬奇机器人手术院内感染发生的危险因素，提出预防及应对措施，为提高机器人辅助 甲状腺手术治疗效果，降低术后感染率提供有效参考。方法：回顾性分析 2014 年 1 月—2022 年 10 月在中国人民解放军联 勤保障部队第九六〇医院甲状腺乳腺外科接受达芬奇机器人手术发生院内感染的 15 例甲状腺疾病患者的临床资料，并对患 者年龄、性别、感染部位、白细胞计数、手术持续时间、血糖、基础代谢率、合并基础疾病、留置引流管时长、住院时长、 并发症、是否使用抗菌药物等情况进行统计分析。结果：主要感染原因是合并基础疾病、皮下积液、侵袭性操作、手术时长、 Ⅱ类切口、肥胖、吸烟等感染高危因素，通过清洁切口与换药、消除无效腔、前期基础疾病预防、提高无菌意识、提升机器 人操作技巧、合理使用抗生素等措施，感染均已控制。机器人辅助手术感染率为 0.57%，所有患者经术后随访，感染已完全 缓解，无后遗症。结论：甲状腺疾病患者行机器人辅助甲状腺手术院内感染发生率低，对于存在感染高危因素患者，临床应 积极采取相应的预防措施，降低机器人辅助甲状腺手术院内感染风险。

Objective: To analyze the risk factors for the occurrence of nosocomial infection in patients who underwent Da Vinci robotassisted thyroid surgery, propose preventive and management measures to provide effective references for improving the efficacy of robotassisted thyroid surgery and reducing postoperative infection rates. Methods: A retrospective analysis was conducted on the clinical data of 15 thyroid disease patients who developed nosocomial infections after Da Vinci robot-assisted surgery in the Department of Thyroid and Breast Surgery at the 960th Hospital of the PLA Joint Logistics Support Force from January 2014 to October 2022. Statistical analysis was performed on factors including age, gender, infection site, white blood cell count, surgery duration, blood glucose level, basal metabolic rate, comorbid chronic diseases, duration of drainage tube placement, length of hospital stay, complications, and antibiotic usage. Results: The primary causes of infection included comorbid chronic diseases, subcutaneous effusion, invasive procedures, prolonged surgery duration, type II surgical incisions, obesity, and smoking. Infections were effectively controlled through measures such as wound cleaning and dressing, elimination of dead space, prevention of underlying chronic diseases, enhanced aseptic awareness, improved robotic operation skills, and rational antibiotic use. The infection rate for robot-assisted surgery was 0.57%. All patients showed complete resolution of infections during postoperative follow-up, with no sequelae. Conclusion: The incidence of nosocomial infections in thyroid disease patients undergoing robot-assisted thyroid surgery is low. For patients with high-risk infection factors, proactive clinical preventive measures should be implemented to minimize the risk of nosocomial infections in robot-assisted thyroid surgery.

基金项目：山东省医药卫生科技发展计划项目（202204011069）；解放军联勤保障部队医学重点学科项目 

Foundation Item: Medical and Health Technology Development Plan Project of Shandong Province(202204011069); Key Medical  Discipline Project of Joint Logistics Support Force of the People’s Liberation Army of China 

引用格式：陈岚清，周鹏，李小磊，等 . 机器人辅助甲状腺手术院内感染危险因素及对策 [J]. 机器人外科学杂志（中英文），2025，6（3）： 445-449. 

Citation: CHEN L Q, ZHOU P, LI X L, et al. Risk factors and countermeasures for nosocomial infection in robot-assisted thyroid surgery [J].  Chinese Journal of Robotic Surgery, 2025, 6(3): 445-449. 

通讯作者（Corresponding Author）：贺青卿（HE Qingqing），Email：heqingqing@yeah.net

[1] Siegel R L, Miller K D, Fuchs H E, et al. Cancer statistics, 2022[J]. CA Cancer J Clin, 2022, 72(1): 7-33. 

[2] Kang S W, Jeong J J, Yun J S, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients[J].Surg Endosc, 2009, 23(11): 2399-2406. 

[3] 贺青卿 , 周鹏 , 庄大勇 , 等 . 经腋窝与胸前径路 da Vinci Si 机器人甲 状腺腺叶切除二例 [J] 国际外科学杂志 , 2014, 41(0): 104-107, 147. 

[4] 贺青卿 . 规范达芬奇机器人外科手术系统在甲状腺手术中的应用 [J]. 中华外科杂志 , 2017, 55(0): 570-573. 

[5] 中华人民共和国卫生部 . 医院感染诊断标准 (试行 )[J].中华医学杂志 , 2001(5): 61-67. 

[6] 中华人民共和国卫生部 . 外科手术部位感染预防与控制技术指南 ( 试 行 ) [S].2010． 

[7] 杜明梅 , 邢玉斌 , 继江 , 等 . 医院感染实时监控系统中疑似感染病例 智能判断的实现 [J]. 中国感染控制杂志 , 2012, 11(2): 115-118. 

[8] 中国医师协会外科医师分会甲状腺外科医师委员会 , 中国研究型医 院学会甲状腺疾病专业委员会 . 机器人手术系统辅助甲状腺和甲状 旁腺手术专家共识 [J]. 中国实用外科杂志 , 2016, 36(11): 1165-1170. 

[9] 张磊 , 徐德忠 , 黄久仪 , 等．SF-36 量表中文版的应用及分级截断点 选择的研究 [J]. 中华流行病学杂志 , 2004, 25(1): 69-73. 

[10] 陈璐 . 甲状腺癌术后患者发生医院感染的危险因素及病原学分析 [J]. 中国卫生检验杂志 , 2018, 28(24): 117-120. 

[11] 何春 , 习勋 , 黄兴伟 , 等 . 甲状腺乳头状癌患者术后医院感染危险因 素分析 [J]. 中华医院感染学杂志 , 2016, 26(5): 1011-1013. 

[12] 程勤 , 张玲琳 . 运用餐桌原理创建机器人手术系统无菌屏障 [J]. 局解 手术学杂志 , 2014, 23(6): 654-655. 

[13] 唐鲁 , 李晓芳 , 朱国雄 , 等 . 达芬奇机器人手术与传统腔镜手术护理 配合的比较与启示 [J]. 中国实用护理杂志 , 2016, (14): 1115-1117. 

[14] Angel García D, Martínez Nicolás I, García Marín J A, et al. Risk-adjustment models for clean and colorectal surgery surgical site infection for the Spanish health system [J].Int J Qual Health Care, 2020, 32(9): 599-608. 

[15] Mangram A J, Horan T C, Pearson M L, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee [J]. Infect Control Hosp Epidemiol, 1999, 20(4): 250-280. 

[16] 孙振洁 , 姚美芳 , 管蓓蕾等 . 加强消毒供应室医院感染的管理 [J]. 中 华医院感染学杂志 , 2014, 24(11): 2842-2843, 2846. 

[17] 王平 , 吴国洋 , 田文 , 等 . 经口腔前庭入路腔镜甲状腺手术专家共识 (2018 版 )[J]. 中国实用外科杂志 , 2018, 38(10): 1104-1107. 

[18] Drinkwater C J, Neil M J. Optimal timing of wound drain removal following total joint arthroplasty[J].J Arthroplasty, 1995, 10(2): 185-189. 

[19] Chen S H, Lee C H, Huang K C, et al. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes[J].Eur Spine J, 2015, 24(3): 561-570. 

[20] 郭瑞萍 , 秦红英 , 黄米娜 , 等 . 手术室感染控制策略对术后感染及手 术室空气洁净度的影响研究 [J]. 中华医院感染学杂志 , 2017, 27(23): 5484-5486, 5494. 

[21] 岳涛 , 庄大勇 , 周鹏 , 等 . 达芬奇机器人甲状腺手术中气管损伤并发 症 4 例并文献复习 [J/OL]. 山东大学耳鼻喉眼学报 , 1-8[2022-12-10]. 

[22] Grewal H, Dangayach N, Ahmad U, et al. Treatment of tracheobronchial injuries: a contemporary review[J]. Chest, 2019, 155(3): 595-604． 

[23] Kunutsor S K, Whitehouse M R, Blom A W, et al. Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis[J].PLoS One, 2016, 11(3): e0150866. 

[24] 彭飞 . 导尿管相关尿路感染防控最佳实践——《导管相关感染防控 最佳护理实践专家共识》系列解读之一 [J]. 上海护理 , 2019, 19(6): 1-4. 

[25] Milone M, Musella M, Conzo G, et al. Thyroidectomy in high body mass index patients: a single center experience[J].Int J Surg, 2016.DOI: 10.1016/ j.ijsu.2015.12.054. 

[26] 朱见 , 贺青卿 , 庄大勇 , 等 . 双腋窝乳晕径路达芬奇机器人甲状腺癌 手术并发症防治 [J]. 国际外科学杂志 , 2017, (2): 129-132+146. 

[27] Jones J K, Triplett R G. The relationship of cigarette smoking to impaired intraoral wound healing: a review of evidence and implications for patient care[J]. J Oral Maxillofac Surg, 1992, 50(3): 237-239; discussion 239-240.