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负压伤口疗法治疗不同腹部手术后切口愈合不良的临床效果

王雪欣 相阳 孟尧 马兵 胡晓燕 唐洪泰 贲道锋 肖仕初

王雪欣, 相阳, 孟尧, 等. 负压伤口疗法治疗不同腹部手术后切口愈合不良的临床效果[J]. 中华烧伤杂志, 2021, 37(11): 1054-1060. DOI: 10.3760/cma.j.cn501120-20210518-00194.
引用本文: 王雪欣, 相阳, 孟尧, 等. 负压伤口疗法治疗不同腹部手术后切口愈合不良的临床效果[J]. 中华烧伤杂志, 2021, 37(11): 1054-1060. DOI: 10.3760/cma.j.cn501120-20210518-00194.
Wang XX,Xiang Y,Meng Y,et al.Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations[J].Chin J Burns,2021,37(11):1054-1060.DOI: 10.3760/cma.j.cn501120-20210518-00194.
Citation: Wang XX,Xiang Y,Meng Y,et al.Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations[J].Chin J Burns,2021,37(11):1054-1060.DOI: 10.3760/cma.j.cn501120-20210518-00194.

负压伤口疗法治疗不同腹部手术后切口愈合不良的临床效果

doi: 10.3760/cma.j.cn501120-20210518-00194
基金项目: 

国家自然科学基金面上项目 81871559

海军军医大学第一附属医院“234学科攀峰计划” 2019YXK045

详细信息
    通讯作者:

    肖仕初,Email:huangzhuoxiao4@hotmail.com

Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations

Funds: 

General Program of National Natural Science Foundation of China 81871559

The 234 Subject Peak Climbing Plan of the First Affiliated Hospital of Naval Medical University 2019YXK045

More Information
    Corresponding author: Xiao Shichu, Email: huangzhuoxiao4@hotmail.com
  • 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。

     

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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921.4
    肝癌511.9
    胃癌37.1
    胆囊癌12.4
    胰腺癌12.4
    肾癌12.4
    前列腺癌12.4
    良性疾病
    胆管疾病819.0
    阑尾炎49.5
    消化道穿孔37.1
    结肠造口还纳24.8
    肝脓肿12.4
    脐疝12.4
    其他
    剖宫产24.8
    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1740.5
    脂肪液化1126.2
    切口感染614.3
    深筋膜层2559.5
    缝线反应511.9
    腹腔感染716.7
    切口感染1126.2
    异物排斥12.4
    营养不良12.4
    下载: 导出CSV
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  • 收稿日期:  2021-05-18

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