Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations
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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. -
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参考文献
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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 
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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
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