小切口联合粘贴式负压冲吸器在直肠肛管周围脓肿治疗中的应用

目的探讨小切口联合粘贴式负压冲吸器治疗直肠肛管周围脓肿的效果。方法将我科2007年2月至2010年9月收治的362例直肠肛管周围脓肿患者随机分两组,183例（实验组）采用小切17联合粘贴式负压冲吸器治疗,179例（对照组）采用切开引流治疗,对比两种方法治疗效果。结果两组在治愈率差异无统计学意义（P〉0．05）,但实验组缩短手术时间及住院时间,缩小手术切口长度,并降低术后疼痛评分,与对照组比较差异有统计学意义（P〈0．05）。结论在直肠肛管周同脓肿治疗中,小切口联合粘贴式负压冲吸器具有手术时间及住院时间短、创伤小、术后疼痛轻的特点,具有较高的临床应用价值。     

腹腔镜冲吸器在膀胱镜血凝块清除术中的应用

目的探讨腹腔镜冲吸器在膀胱镜下血凝块清除术中的应用价值。方法回顾性分析本院2010年4月至2014年3月开展的26例膀胱镜下血凝块清除术的临床病例资料。其中良性前列腺增生症10例,前列腺电切术后3例,膀胱肿瘤6例,腺性膀胱炎5例,肾挫裂伤2例;膀胱内血凝块大小为40mm×35mm~100mm×85mm。所有病例均在膀胱镜下利用腹腔镜冲吸器清除血凝块。结果 26例膀胱血凝块全部清除干净,无膀胱、尿道损伤等并发症。结论在膀胱镜下利用腹腔镜冲吸器清除膀胱内血凝块是一种安全有效且快速的方法,值得临床推广。     

无辅助切口腹腔镜技术治疗结直肠肿瘤

目的 研究一种无切口腹腔镜技术在高位直肠及乙状结肠肿瘤微创外科治疗中的可行性并初步探讨其临床应用价值.方法 对12例常规腹腔镜下高位直肠及乙状结肠肿瘤的离体标本进行研究,初步探索该新技术的适应证.并对2例应用该技术的手术病例进行临床资料的分析,通过随访了解其长短期并发症情况.结果 12例连续的高位直肠及乙状结肠离体标本中腺瘤1例、腺癌11例,其中腺瘤病例和4例腺癌病例可在离体标本水平成功模拟该新技术.在初步明确无切口腹腔镜技术的适应证后,成功将该术式应用于1例高位直肠巨大绒毛状腺瘤伴局部癌变病例及1例乙状结肠腺癌病例的微创治疗中.平均手术时间为200 min,平均术中出血量为75 ml,平均肠功能恢复时间为1.5 d,术后平均随访14个月,无任何长短期并发症.结论 无切口腹腔镜技术符合肿瘤根治的原则,在符合适应证的病例中安全可行.与传统术式相比该技术可以简化手术环节,进一步减小创伤,节省手术费用.     

负压封闭引流技术在胸外科手术后胸壁切口感染治疗中的临床应用

目的总结使用负压封闭引流技术治疗胸壁伤口感染的初步经验及体会。方法回顾性分析2011年7月至2013年10月四川大学华西医院16例开胸手术后发生胸壁切口感染患者的临床资料,其中男13例,女3例;年龄（50．8±6．7）岁。手术种类包括脓胸廓清术、肺叶切除术、纵隔肿瘤切除术和食管癌根治术。通过应用负压封闭引流技术,进行伤口的持续负压吸引治疗,观察治疗效果,积累初步经验。结果经过持续负压引流,16例患者中有3例未达到二期缝合的标准（负压封闭引流愈合标准）,其中2例由于患者耐受差,不愿继续使用,转为每日更换敷料;1例由于伤口感染控制不佳,感染范围增加,更换为每日换药治疗。总的负压封闭引流治疗愈合率为81．2％（13／16）。6例（37．5％）患者为多次安置负压封闭引流。累计保留负压封闭引流时间为4～24d,中位时间9d。治疗过程中无负压封闭引流相关不良事件发生。随访11例,随访时间2～8个月,失访5例。11例患者中,1例出现轻微的伤口异物反应（皮下缝线）,经拆除皮下缝线后治愈;其余患者伤口均愈合良好,未见感染复发。结论负压封闭引流技术治疗胸外科手术后胸壁切口感染安全、可行、有效,患者耐受好,具有较高的临床应用价值。而通过初期的使用经验总结,有利于我们拓展负压封闭引流技术的应用领域,整体提高胸外科手术后伤口感染的治疗效果。     

粘贴式负压冲洗治疗颈淋巴结清扫术后乳糜瘘20例临床分析

目的探讨粘贴式负压冲洗在颈淋巴结清扫术后并发乳糜瘘治疗中的作用。方法回顾性分析我院2004年1月至2010年12月期间20例颈淋巴结清扫术后并发乳糜瘘患者的临床资料。结果 20例患者中18例经粘贴式负压冲洗后,在5d内引流量明显减少,住院时间10～12d,平均11.3d;在治疗过程中未出现感染、水肿、皮肤破溃等并发症。另外2例经粘贴式负压冲洗治疗无效,转为手术治疗,分别于术后15d及17d痊愈出院。结论粘贴式负压冲洗是治疗颈淋巴结清扫术后乳糜瘘的较为有效、理想的方法,具有创伤小,愈合时间短,费用少,患者较易接受等优点。     

负压引流器在乳癌手术中的应用体会

负压引流器在乳癌手术中的应用体会山东省枣庄矿务局中心医院普外科（２７７０１１）张钦增于建利１）唐鲁兵韩青阳乳癌根治术后皮下积液与皮瓣坏死是其主要并发症。我科自１９９１年开始在乳癌术后应用一次性负压引流器（以下称负压引流器），既减少了皮下积液的发生率，...     

腹腔镜结直肠癌术后切口感染的影响因素分析

目的：探讨结直肠癌腹腔镜手术后切口感染的影响因素。 方法：回顾性分析中国医科大学附属盛京医院结肠直肠肿瘤外科697例结直肠癌手术患者的临床资料,对可能影响切口感染的相关因素进行单因素与多因素分析。 结果：697例手术中有43例出现切口感染43/697（6.17%）,单因素分析显示,结直肠癌手术切口感染与性别、年龄、手术时间、手术方式、是否合并基础疾病有关（均P<0.05）;Logistic回归显示,手术方式、年龄及手术时间为切口感染的独立影响因素（均P<0.05）。 结论：手术方式、年龄及手术时间是腹腔镜结直肠癌手术术后患者切口感染的独立影响因素。如病情允许,结直肠癌腹腔镜手术应作为减少术后切口感染率的首选手术术式。     

侧孔抽吸式负压吸乳器的应用性研究

目的探讨扁平或凹陷乳头的有效矫正方法及侧孔抽吸式负压吸乳器的效果.方法将122例乳头扁平或凹陷的初产妇分为三组.观察组(38例)用自行研制的侧孔抽吸式负压吸乳器矫正,对照1组(42例)用一次性注射器抽吸矫正,对照2组(42例)用市售吸乳器矫正.结果矫正后乳头伸展长度,乳腺管疏通数,吸乳器每次持续作用时间、使用次数等指标观察组与对照1、2组比较,差异有显著性意义(均P＜0.01).矫正后哺乳成功率观察组与对照1组比较,差异无显著性意义(P＞0.05);与对照2组比较,差异有显著性意义(P＞0.05);矫正过程中产妇舒适度观察组与对照1组比较,差异有显著性意义(P＜0.01);与对照2组比较,差异无显著性意义(P＞0.05).结论侧孔抽吸式负压吸乳器矫正扁平或凹陷乳头的效果优于注射器抽吸和市售吸乳器矫正法,在使用过程中能减轻产妇痛苦,使产妇感觉舒适,乐于接受;矫正后产后早期哺乳成功,增强母乳喂养信心,提高母乳喂养率.     

负压封闭引流装置在术后腹部切口感染防治上的临床应用

目的 总结负压封闭引流装置在术后腹部切口感染防治上的临床疗效及注意事项.方法 2009年7月至2012年7月腹部开放手术1 056例,分为对照组(713例)和实验组(343例),比较两组切口感染率、换药总次数、愈合时间等.结果 负压封闭引流装置在术后腹部切口感染防治上疗效显著,住院时间短、费用低.结论 正确使用负压封闭引流装置能有效防治术后腹部切口感染.     

切口保护开创器在腹腔镜结直肠手术中的应用

目的探讨切口保护开创器在腹腔镜结直肠癌切除术中的临床应用效果。方法32例结直肠癌在行腹腔镜手术时辅助小切口使用切口保护开创器。逐层切开辅助小切口进入腹腔后,首先将切口保护开创器的固定环经小切口放入腹腔内,固定环自动张开恢复为圆形,然后连续翻转牵拉环同时卷绕硅胶薄膜套管使其绷紧,直到切口保护开创器固定在辅助小切口周围。结果辅助切口下手术视野整体显露良好,无须助手牵拉手术切口。辅助切口长度4.0~6.5cm,平均4.5cm。术后32例辅助切口均一期愈合,无切口感染。住院时间7~16d,平均8d。32例随访3~12个月,无辅助手术切口和操作孔肿瘤种植转移。结论切口保护开创器使用简单,对切口提供良好保护;手术切口能够自动敞开,无需助手用拉钩牵拉;优化了腹腔镜结直肠手术肠管取出和离断步骤,具有良好的开发应用前景。     

负压吸引对肺手术后临床疗效的Meta分析

目的评价肺手术后胸腔闭式引流系统加用负压吸引的临床效果。方法计算机检索Cocharane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间从各数据库建库至2015年1月;同时辅助其他检索,纳入肺手术后胸腔闭式引流系统加用负压吸引的随机对照试验(RCT)。由两名评价者独立评价纳入研究的质量并提取资料,并用Rev Man 5.0软件进行统计分析。结果共纳入10个随机对照试验,包括1211例患者。Meta分析结果显示,加用负压吸引能明显减少术后气胸的发生率[OR=0.23,95%CI(0.10,0.54),P0.01];带管时间、漏气时间、迁延漏气时间、肺炎、心肺并发症、住院时间的差异均无统计学意义(P均0.05)。结论肺切除术后胸腔闭式引流系统加用负压吸引并无明显优势,不提倡使用。     

Wound infection after elective laparoscopic surgery for colorectal carcinoma

Background The aim of this study was to evaluate various clinical parameters that would influence the occurrence of wound infection (WI) in elective laparoscopic surgery (LS) for colorectal carcinoma. Methods The study included 290 patients who underwent LS between June 2001 and December 2005. WI was diagnosed within 30 days of the operation, and both superficial and deep incision surgical site infection were evaluated together. Results Eighteen (6.2%) were diagnosed with WI. Of the infected patients, nine (50%) had WI at the extraction site, six (33%) at the port site of the drainage tube, and three (17%) at the supraumbilical incision. Following bivariate analysis, the variables of stoma creation, intraoperative hypotension, and length of operation were selected for multivariate analysis as their P values were <0.2, the predominant cutoff, and stoma creation and intraoperative hypotension were independently predictive of developing WI. Regarding the duration of postoperative hospital stay, there was no significant difference between patients with or without WI. Conclusions Stoma creation and intraoperative hypotension were independent risk factors for WI. The results obtained in this study should be considered in an effort to prevent WI in LS for colorectal carcinoma, although these risk factors need further evaluation.     

自制简易负压吸引装置在创面修复术前的应用

目的:探讨自制简易负压吸引装置在创面修复术前期准备中的治疗作用。方法:对27例有皮肤软组织缺损的患者采用自制的简易负压吸引装置治疗,并在每次更换负压装置时进行清创。经过7～30日,平均15.6日的治疗后,在创面上行二期游离植皮或皮瓣转移修复术。结果:27例患者经过治疗后创面清洁,面积较前缩小,肉芽生长新鲜,游离植皮或皮瓣转移修复均一次性获得成功。结论:自制简易负压吸引结合间断清创能够减少创面污染,促进肉芽组织生长,促进创面的愈合,为二期手术创造条件,缩短术前准备时间,且减轻医务人员换药工作量,减轻患者痛苦。     

简易持续负压吸引在深度创面的应用观察及护理

目的：探讨简易持续负压吸引对促进深度创面愈合的疗效及护理。方法：50例患者分为治疗组25例和对照组25例,对照组给予常规换药,治疗组用简易材料进行持续负压吸引,比较两组的换药次数、应用抗生素费用及总住院时间等指标,评估疗效。结果：在换药次数、应用抗生素费用及总住院时间等,治疗组均优于对照组。结论：简易负压吸引是一种良好的促进深度创面愈合的方法,配合创面观察及护理,疗效优于传统方法,值得推广。     

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.     

Wound infection after a laparoscopic resection for colorectal cancer

PURPOSE: The aim of this study was to investigate whether the wound infection (WI) rate in laparoscopic surgery (LS) for colorectal cancer is lower than that in open surgery (OS), and to evaluate the influence of perioperative intravenous antibiotic prophylaxis on the development of WI in LS. METHODS: We performed a meta-analysis study comparing the WI rate in patients who underwent either OS or LS in randomized controlled trials (RCTs), with a relatively large number of registered patients. Moreover, a subgroup analysis of recently reported RCTs from Japan was performed, and 290 consecutive patients who underwent LS for colorectal cancer at our institution were evaluated for the influence of perioperative intravenous antibiotic prophylaxis on the development of WI. RESULTS: The WI rate of the LS group was significantly lower than that of the OS group in a meta-analysis; however, no positive effect of the intra-and postoperative antibiotic prophylaxis on the development of WI was demonstrated. CONCLUSIONS: Laparoscopic surgery for colorectal cancer is considered a surgical technique that has a lower incidence of WI in comparison to OS. Well-designed prospective, randomized controlled trials should therefore be conducted to evaluate whether intraoperative repeated dosing or postoperative repeated dosing is effective in reducing WI in LS.     

The wound adjuncts effect of closed incision negative pressure wound therapy on stopping groin surgical site wound infection in arterial surgery: A meta-analysis

A meta-analysis study was conducted to assess the influence of the wound adjuncts therapy of closed incision negative pressure wound therapy (ciNPWT) on stopping groin site wound infection (SWSI) in arterial surgery. A comprehensive literature examination till January 2023 was implemented and 2186 linked studies were appraised. The picked studies contained 2133 subjects with groin surgical wounds of arterial surgery in the picked studies' baseline, 1043 of them were using ciNPWT, and 1090 were using standard care. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the wound adjuncts therapy of ciNPWT on stopping groin SWSI in arterial surgery by the dichotomous and continuous styles and a fixed or random model. The ciNPWT had a significantly lower SWSI (OR, 0.42; 95% CI, 0.33–0.55, P < .001), superficial SWSI (OR, 0.46; 95% CI, 0.33–0.66, P < .001), and deep SWSI (OR, 0.39; 95% CI, 0.25–0.63, P < .001) compared with the standard care in groin surgical wound of arterial surgery. The ciNPWT had a significantly, lower SWSI, superficial SWSI, and deep SWSI compared with the standard care in groin surgical wounds of arterial surgery. Although precautions should be taken when commerce with the consequences because some of the picked studies for this meta-analysis was with low sample sizes.     

Impact of the extraction-site location on wound infections after laparoscopic colorectal resection

Background

The purpose of this study was to determine the impact of the incision used for specimen extraction on wound infection during laparoscopic colorectal surgery.

Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence

The use of topical negative pressure (TNP) dressings for sternal wound dehiscence or mediastinitis in the neonatal population is rare. The majority of case reports have focused on wound healing as an endpoint and have not discussed the physiological advantage that TNP dressings may impart with regard to sternal stabilisation, improved respiratory function and early weaning from mechanical ventilation. We present a case of the use of TNP in neonatal post-sternotomy wound dehiscence and mediastinitis, from a UK perspective, with an emphasis on wound healing and physiological optimisation. As well as an improvement in sternal wound healing due to the local effects of the TNP system, serial arterial blood gas analysis revealed a significant improvement in systemic physiological parameters, including a reduction in pCO(2) in the period (days 20-31) after application of TNP (p<0.0001) compared to the period before where simple occlusive dressings were applied. Hydrogen ion concentration also significantly reduced in this period (p=0.0058). The use of the TNP system in association with systemic antibiotics successfully treated the mediastinitis. A sealed, controlled wound environment also allowed ease of nursing and an expedited return to care by the parents. We would recommend the consideration of TNP dressings in similar cases of neonatal and paediatric sternal wound dehiscence. Not only do we observe the local effects of improved wound healing, the systemic effects of improved lung function are also valuable in the early management of such complex cases.