Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations
-
摘要:
目的 探讨采用负压伤口疗法（NPWT）治疗不同腹部手术后切口愈合不良的临床效果。 方法 采用回顾性观察性研究。2019年6月—2020年12月，海军军医大学第一附属医院烧创伤中心收治42例腹部手术后切口愈合不良的患者，其中男29例、女13例，年龄23~81岁，腹部切口愈合不良病程3~60 d。患者入院后完善术前检查，清创后采用NPWT治疗，根据切口裂开层次将负压值设置为-10.64~-6.65 kPa。待切口血运良好，进行Ⅱ期切口缝合。统计腹部手术原因、腹部切口裂开层次和愈合不良原因，观察腹部切口最终愈合情况及并发症发生情况。 结果 本组患者出现腹部切口愈合不良的腹部手术原因按构成比排名，前4位是结肠癌（9例，占21.4%）、胆管疾病（8例，占19.0%）、肝癌（5例，占11.9%）和阑尾炎（4例，占9.5%）。腹部切口裂开层次在深筋膜层者25例（59.5%）、浅筋膜层者17例（40.5%）。腹部切口愈合不良原因按构成比排名，前3位是感染（24例，占57.1%）、脂肪液化（11例，占26.2%）、缝线反应（5例，占11.9%）。40例患者经NPWT治疗，切口血运改善，行Ⅱ期缝合，第2~3周拆除缝线，切口愈合良好；另外2例患者在使用NPWT治疗期间分别出现了肠瘘、胆漏，拆除负压装置，经充分引流和常规换药治疗后切口愈合。 结论 NPWT治疗不同腹部疾病手术后切口愈合不良，效果较佳，但临床医师需综合评估患者病情决定NPWT的使用时机和使用方式，避免肠瘘、胆漏等并发症的发生。 Abstract:Objective To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications. -
所有作者均声明不存在利益冲突广告目次深圳市源兴医药股份有限公司 …………………………………………………………………………………………… 封二上海铠唏尔医疗器械贸易有限公司 …………………………………………………………………………………… 对封二南海朗肽制药有限公司 ………………………………………………………………………………………… 对中文目次1江西省科星生物工程有限公司 ………………………………………………………………………………… 对中文目次2上海腾瑞制药股份有限公司 …………………………………………………………………………………… 对英文目次1保赫曼（上海）贸易有限公司 …………………………………………………………………………………… 对英文目次2浙江医学科技开发有限公司 …………………………………………………………………………………………… 插页3苏州汇涵医用科技发展有限公司 ……………………………………………………………………………………… 插页4苏州爱得科技发展股份有限公司 ……………………………………………………………………………………… 对正文珠海亿胜生物制药有限公司 ……………………………………………………………………………………………… 封三武汉维斯第医用科技股份有限公司 ……………………………………………………………………………………… 封底
-
参考文献
(35) [1] AllegranziB, ZayedB, BischoffP, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective[J]. Lancet Infect Dis, 2016, 16 (12): e288-e303. DOI: 10.1016/S1473-3099(16)30402-9. [2] 中国医师协会创伤外科医师分会. 负压封闭引流技术腹部应用指南[J]. 中华创伤杂志,2019,35(4):289-302. DOI: 10.3760/cma.j.issn.1001-8050.2019.04.001. [3] Sandy-HodgettsK, LeslieGD, ParsonsR, et al. Prevention of postsurgical wound dehiscence after abdominal surgery with NPWT: a multicentre randomised controlled trial protocol[J]. J Wound Care 2017,26(Suppl 2): S23-26. DOI: 10.12968/jowc.2017.26.Sup2.S23. [4] 林小婷,吴美宁,谢小蔓,等. 外科手术患者医院感染的危险因素分析[J]. 中华医院感染学杂志,2015,25(15): 3497-3498,3524. DOI: 10.118116/cn.ni.2015-142020. [5] 刘源炜,陈必成,陈杰,等.结肠癌根治术患者术后切口感染病原菌及影响因素分析[J].中华医院感染学杂志,2018,28(15):2341-2344.DOI: 10.11816/cn.ni.2018-173279. [6] 陈涛,金曜.急性胆囊炎术后医院感染病原菌及影响因素[J].中华医院感染学杂志,2020,30(14):2184-2187.DOI: 10.11816/cn.ni.2020-190118. [7] 周建春,赵孝杰,彭启平,等.胆道手术患者胆汁培养及抗菌药物耐药性分析的临床研究[J].中华医院感染学杂志,2011,21(7):1464-1467. [8] 承文龙,齐永强,陈勇军.肝癌肝切除术后感染并发症相关危险因素的Meta分析[J].中华肝胆外科杂志,2016,22(1):5-8.DOI: 10.3760/cma.j.issn.1007-8118.2016.01.002. [9] WellsCI, RatnayakeCBB, PerrinJ, et al. Prophylactic negative pressure wound therapy in closed abdominal incisions: a meta-analysis of randomised controlled trials[J]. World J Surg, 2019,43(11):2779-2788. DOI: 10.1007/s00268-019-05116-6. [10] WillyC, AgarwalA, AndersenCA, et al. Closed incision negative pressure therapy: international multidisciplinary consensus recommendations[J]. Int Wound J, 2017, 14(2): 385- 398. DOI: 10.1111/iwj.12612. [11] GaoJ, WangY, SongJ, et al. Negative pressure wound therapy for surgical site infections: a systematic review and meta- analysis [J]. J Adv Nurs, 2021, 77(10):3980-3990. DOI: 10.1111/jan.14876. [12] JentzschT,OsterhoffG,ZwolakP,et al.Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study[J].Arch Orthop Trauma Surg,2017,137(1):55-62.DOI: 10.1007/s00402-016-2600-z. [13] MoogP,JenschM,BetzlJ,et al.Bacterial bioburden of wounds: influence of debridement and negative-pressure wound therapy (NPWT)[J].J Wound Care,2021,30(8):604-611.DOI: 10.12968/jowc.2021.30.8.604. [14] BorgquistO,IngemanssonR,MalmsjöM.Wound edge microvascular blood flow during negative-pressure wound therapy: examining the effects of pressures from -10 to -175 mmHg[J].Plast Reconstr Surg,2010,125(2):502-509.DOI: 10.1097/PRS.0b013e3181c82e1f. [15] 谢闪亮,郭光华,闵定宏.封闭负压引流技术在创面愈合中的应用及机制研究进展[J].中华烧伤杂志,2017,33(6):397-400.DOI: 10.3760/cma.j.issn.1009-2587.2017.06.024. [16] 陈孝强,张伟,李学拥.负压伤口疗法促进创面愈合的生物力学效应研究进展[J].中华烧伤杂志,2018,34(4):243-246.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.010. [17] JiS,LiuX,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2021-10-20]. https://pubmed.ncbi.nlm.nih.gov/34212064/. DOI: 10.1093/burnst/tkab018. [18] TopazM,AshkenaziI,BarzelO,et al.Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study[J/OL].Burns Trauma,2021,9:tkab007[2021-10-20]. https://pubmed.ncbi.nlm.nih.gov/34212059/. DOI: 10.1093/burnst/tkab007. [19] SogorskiA,LehnhardtM,GoertzO,et al.Improvement of local microcirculation through intermittent negative pressure wound therapy (NPWT)[J].J Tissue Viability,2018,27(4):267-273.DOI: 10.1016/j.jtv.2018.08.004. [20] AydinD,PaulsenIF,BentzenVE,et al.Reconstruction of massive full-thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and split-skin grafting[J].Clin Case Rep,2016,4(10):982-985.DOI: 10.1002/ccr3.649. [21] BertelsenCA,FabriciusR,KleifJ,et al.Outcome of negative-pressure wound therapy for open abdomen treatment after nontraumatic lower gastrointestinal surgery: analysis of factors affecting delayed fascial closure in 101 patients[J].World J Surg,2014,38(4):774-781.DOI: 10.1007/s00268-013-2360-7. [22] JefferySL.The use of an antimicrobial primary wound contact layer as liner and filler with NPWT[J].J Wound Care,2018,23(8 Suppl):S3-14.DOI: 10.12968/jowc.2014.23.Sup8.S1. [23] 吕国忠,杨敏烈.规范应用负压伤口疗法提高创面修复水平[J].中华烧伤杂志, 2020,36(7):523-527. DOI: 10.3760/cma.j.cn501120-20200522-00280. [24] ZeidermanMR,PuLLQ.Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL].Burns Trauma,2021,9:tkab024[2021-10-21]. https://pubmed.ncbi.nlm.nih.gov/34345630/. DOI: 10.1093/burnst/tkab024. [25] FuX. Wound healing center establishment and new technology application in improving the wound healing quality in China[J/OL]. Burns Trauma, 2020, 8:tkaa038[2021-05-18]. https://pubmed.ncbi.nlm.nih.gov/33134399/. DOI: 10.1093/burnst/tkaa038. [26] ChengHT,HsuYC,WuCI.Efficacy and safety of negative pressure wound therapy for Szilagyi grade III peripheral vascular graft infection[J].Interact Cardiovasc Thorac Surg,2014,19(6):1048-1052.DOI: 10.1093/icvts/ivu289. [27] NolffMC, Meyer-LindenbergA. Negative pressure wound therapy (NPWT) in small animal medicine. Mechanisms of action, applications and indications[J]. Tierarztl Prax Ausg K Kleintiere Heimtiere,2016,44(1):26-37; quiz 38. DOI: 10.15654/TPK-150957. [28] ChengB, TianJ, PengY,, et al. Iatrogenic wounds: a common but often overlooked problem[J/OL]. Burns Trauma, 2019, 7:18[2021-05-18]. https://pubmed.ncbi.nlm.nih.gov/31165077/. DOI: 10.1186/s41038-019-0155-2. [29] CristaudoA,JenningsS,GunnarssonR,et al.Complications and mortality associated with temporary abdominal closure techniques: a systematic review and meta-analysis[J].Am Surg,2017,83(2):191-216. [30] 赵耀华, 夏成德, 邵国益, 等. 软组织分层放置自制引流管行负压伤口疗法的临床应用33例[J]. 中华烧伤杂志,2020,36(6):493-496. DOI: 10.3760/cma.j.cn501120-20190327-00142. [31] SeternesA,RekstadLC,MoS,et al.Open abdomen treated with negative pressure wound therapy: indications, management and survival[J].World J Surg,2017,41(1):152-161.DOI: 10.1007/s00268-016-3694-8. [32] 张永存, 王亮, 鲁晋,等. 腹部巨大切口术后胀裂伴感染一例[J]. 中华烧伤杂志,2017,33(10):644-645. DOI: 10.3760/cma.j.issn.1009-2587.2017.10.013. [33] 张连阳.腹部外科中的负压封闭引流现状及展望[J]. 创伤外科杂志, 2016, 18(8): 449-451. DOI: 10.3969/j.issn.1009-4237.2016.08.001. [34] 郑涛, 解好好, 吴秀文, 等. 全国多中心肠外瘘诊治情况调查及预后风险分析[J]. 中华胃肠外科杂志,2019, 22(11): 1041-1050. DOI: 10.3760/cma.j.issn.1671-0274.2019.11.007. [35] 于安星, 吴承先, 刘哲. 腹腔镜胆总管切开一期缝合术后胆漏的原因及处理方法[J]. 中华肝胆外科杂志,2016.22(7):490-492. DOI: 10.3760/cma.j.issn.1007-8118.2016.07.018. -
1 采用负压伤口疗法（NPWT）治疗例1患者右半结肠癌切除、回结肠断端吻合术后腹部切口愈合不良。1A.NPWT治疗第5天，可见肠液外溢；1B.NPWT治疗第5天，拆除负压装置可见肠液持续外溢；1C.常规换药治疗1周，瘘口位于切口下端，肠液引流量减少；1D.常规换药治疗3周，瘘口缩小，切口新鲜，肉芽组织增生明显；1E.常规换药治疗5周，瘘口闭合，切口部分愈合；1F.常规换药治疗7周，切口愈合良好
2 采用负压伤口疗法（NPWT）治疗例2患者胆囊切除、胆总管切开取石、胆道T型引流管置入术后腹部切口愈合不良。2A.入院时腹部切口感染、裂开；2B.NPWT治疗切口第2天；2C.使用NPWT治疗第3天，胆汁持续从切口渗出；2D.拆除负压装置，常规换药治疗3周，切口基本愈合
表1 42例腹部切口愈合不良患者腹部手术的原因
腹部手术原因分类及具体原因 例数 构成比（%） 恶性肿瘤 结肠癌 9 21.4 肝癌 5 11.9 胃癌 3 7.1 胆囊癌 1 2.4 胰腺癌 1 2.4 肾癌 1 2.4 前列腺癌 1 2.4 良性疾病 胆管疾病 8 19.0 阑尾炎 4 9.5 消化道穿孔 3 7.1 结肠造口还纳 2 4.8 肝脓肿 1 2.4 脐疝 1 2.4 其他 剖宫产 2 4.8 
下载: 导出CSV
表2 42例腹部切口愈合不良患者腹部切口裂开层次及愈合不良原因
裂开层次及原因 例数 构成比（%） 浅筋膜层 17 40.5 脂肪液化 11 26.2 切口感染 6 14.3 深筋膜层 25 59.5 缝线反应 5 11.9 腹腔感染 7 16.7 切口感染 11 26.2 异物排斥 1 2.4 营养不良 1 2.4
下载: 导出CSV
-
图(2) / 表(2)
计量
- 文章访问数: 323
- HTML全文浏览量: 241
- PDF下载量: 58
- 被引次数: 0
