自制皮下引流管持续冲洗负压吸引预防腹部切口感染的双中心随机对照研究

目的探讨自制皮下引流管持续冲洗负压吸引预防腹部Ⅳ类切口感染的价值。 方法将2012年1月至2017年1月在佛山市第一人民医院普外科和伽师县人民医院普外科行Ⅳ类切口开腹手术的220例患者随机分为试验组和对照组。试验组患者关腹时放置自制皮下引流管,术后持续负压冲洗3 d后拔除;对照组采用传统不放置皮下引流管的关腹方法。观察并比较两组患者术后伤口恢复情况及围手术期临床资料。 结果试验组平均术后住院时间、术后治疗费用、总治疗费用显著低于对照组,差异均有统计学意义（P<0.01）。两组腹腔液细菌培养结果差异无统计学意义（χ²=0.017,P=0.992）,试验组的切口愈合程度显著优于对照组（χ²=8.208,P=0.017）,切口感染发生率显著低于对照组（χ²=8.206,P=0.004）。多因素分析结果显示,是否放置皮下引流管（P=0.008）、原发疾病部位（P=0.004）、术前降钙素原水平（P=0.008）、合并糖尿病（P=0.006）是术后伤口感染的危险因素。 结论Ⅳ类切口手术放置自制皮下引流管持续冲洗和负压吸引,能有效预防术后切口感染,减少住院时间,降低住院费用。     

负压引流治疗腹部手术切口渗液18例

目的 探讨皮下持续负压引流术对腹部切口脂肪液化或感染的治疗作用.方法 选取2001年7月至2011年9月行腹部手术的病人36例,随机分为传统方法组与负压引流组各18例,传统组按传统方法对液化或感染伤口进行部分拆线撑开,挤压切口下渗血、渗液填塞纱条引流换药,创面肉芽理想后二期缝合.负压引流组切口敞开清创放置负压引流管后缝合切口,连续3d无引流液且体温正常后拔管,术后常规时间拆线,均达到甲级愈合.结果 对照组切口完全愈合时间8～35 d,平均21 d;负压引流组切口愈合时间7～10d,平均8.2d;两组对比差异有统计学意义(P＜0.01).结论 在腹部术后切口液化或感染采用敞开切口清创缝合并放置持续负压引流能早期达到切口愈合,简单、有效,值得基层医院推广使用.     

持续冲洗加肠造口袋负压引流治疗脓肿13例报告

脓肿是外科常见病,临床处理有一定的困难。切开引流是基本的治疗措施,常规引流和换药处理耗时长、效果差。我们采用肠造口袋和自制双腔引流管持续灌洗负压引流治疗各类脓肿13例,临床效果满意,现报告如下。1资料和方法1.1一般资料本组13例,男9例,女4例。年龄最大69岁,最小26岁,平均52岁。乳腺深部脓肿3例,腹腔脓肿2例,肛周脓肿3例,臀部深部脓肿2例,腹壁脓肿1例,足部脓肿2例。1.2方法取康乐保(Coloplast)肠造口袋一个,医用橡胶引流管或粗肛管一根,再取普通输液管一根。粗管子前端剪2～4个侧孔,输液管剪侧孔后和粗管并排绑在一起。根据脓肿切…     

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.     

直肠癌患者预防性肠造口还纳术后短期肛门功能情况评估

目的评估接受预防性肠造口直肠癌患者术后短期肛门功能恢复情况,为长期预后提供依据。方法采用Weber、Vaizey、Pescatori、AMS四种肛门功能评估量表对19例患者首次手术及还纳术后3个月的肛门功能进行评估,评估术后肛门功能恢复情况。结果不同年龄、性别、肿瘤分期的患者其术后肛门功能量表得分无明显差异,四种量表评分结果具有统计学正相关性。1例患者接受永久性造口,其余18例患者术后3个月Weber、Vaizey、Pescatori、AMS量表得分高于首次手术之前,其中Wexner量表得分（3．39±1．03与0．44±0．20,P：0．011）,气体（Z=－3．742,P〈0．001）、液体（Z=－4．085,P〈0．001）和固体失禁（Z=－2．000,P=0．046）得分均较术前升高,提示患者还纳术后3个月的肛门功能较首次手术前差;而衬垫使用（P=0．344）及生活方式改变（P＝0．144）差异无统计学意义,说明患者术后的生活方式并未受到明显影响。结论接受预防性造口的直肠癌患者肛门功能较术前有一定程度的下降,但是患者生活方式并未发生明显改变,肛门功能仍在可接受范围内。     

保留内置物清创联合真空负压封闭引流治疗早发性腰椎融合术后感染

目的回顾分析保留内置物清创联合真空负压封闭引流治疗早发性腰椎融合术后感染的疗效。方法785例腰椎后路融合病例中术后早发性深部伤口感染6例,均为术后30d内出现发热、疼痛加重等症状,并伴有炎性指标升高,均采用保留内置物,彻底清创后持续冲洗负压引流,抗炎治疗。结果清创术后腰痛即明显缓解,体温下降,2周左右伤口渗液停止,疼痛消失,血常规和C反应蛋白检查结果正常,血沉明显下降。随访平均35．3个月,末次随访时X线片提示腰椎植骨融合。JOA评分改善率为82．2％。结论对于早发性腰椎融合术后感染病例,进行积极清创手术,保留内置物联合真空负压封闭引流能够及时控制感染,是一种较为有效的处理。日服抗生素抑菌治疗可以降低清创术术后感染复发。     

持续冲洗负压引流治疗四肢骨折术后感染

目的探讨持续冲洗负压引流治疗四肢骨折术后并发感染的疗效。方法对四肢骨折术后并发感染47例采用病灶扩创、伤口持续灌洗负压引流、全身应用抗生素、治疗原发病及营养支持等治疗。结果 47例均随访0.5~3年。骨折愈合40例,骨不连7例。感染复发7例,再行负压吸引及全身应用抗生素。截肢1例,截趾1例。结论采用持续冲洗负压引流治疗四肢骨折术后感染,可实现彻底、全方位引流,阻止内置物与骨之间生物膜的形成,控制感染,减少复发,防止内置物松动,提高骨折愈合率,比常规引流有更好的疗效。     

负压封闭引流技术治疗感染创面的临床观察

目的 观察负压封闭引流技术(VSD)治疗感染创面的效果.方法 对15例创面感染患者行创面彻底清创后予VSD治疗.结果 2例经1次VSD、1例2次VSD后,直接缝合.6例1次VSD、2例2次VSD、1例3次VSD后,植皮治疗成功.3例1次VSD后创面瘢痕愈合.结论 VSD能阻止外界细菌进入创面,通畅引流,增强创面抗感染能力,促进创面愈合.     

负压封闭引流治疗腹部术后切口化脓性感染的临床疗效

开放换药是治疗腹部术后切口化脓性感染的传统方法 ,其不足是治疗时间较久 ,住院时间长 ,频繁换药 ,加重了患者的痛苦 ,也增加了医护人员的工作量。我们自 1994年 7月起 ,采用负压封闭引流 (ｖａｃｕｕｍｓｅａｌｉｎｇｄｒａｉｎａｇｅ ,ＶＳＤ)新技术治疗腹部术后切口化脓性感染 ,现与开放换药的患者相对照 ,以评价ＶＳＤ的临床疗效。一、资料和方法1.临床资料 :腹部术后切口肿痛 ,敞开证实为化脓性感染 ,但符合下列其中一个条件的患者除外 :(1)腹腔脓肿或消化系瘘累及切口 ;(2 )合并有糖尿病。分负压封闭引流组 (简称封闭组 )和开放换药…     

应用负压封闭引流技术治疗腰椎融合术后切口深部感染的临床效果

目的 探讨负压封闭引流(VSD)技术对腰椎融合术后切口深部感染的疗效.方法 对2009年1月至2018年12月华南理工大学附属第六医院脊柱外科采用VSD治疗的腰椎后路融合内固定术后感染患者8例的临床资料进行回顾性分析.其中男3例,女5例,年龄(67.14±3.13)(62～77)岁.患者术后畏寒高热,腰部疼痛加重,实验...     

负压封闭引流与常规敷料加压包扎治疗大面积皮肤撕脱伤的疗效对比研究

目的探讨负压封闭引流技术治疗大面积皮肤撕脱伤的临床疗效。方法对本院2007年3月—2010年8月采用原位全厚皮片回植方法治疗的62例大面积皮肤撕脱伤病例进行回顾性研究,其中多聚乙烯醇明胶海绵覆盖回植皮片、持续负压封闭吸引（负压引流组）35例,传统敷料加压包扎覆盖回植皮片（敷料加压组）27例。观察两组术后皮片成活情况、创面感染率和创面愈合效果,记录平均住院时间。结果负压引流组中有31例回植全厚皮片全部成活,皮片成活率88.6%,余4例皮片存活面积〉95%,;2例遗留创面感染,感染率5.7%;平均住院时间（12.3±5.4）d。敷料加压组全部成活18例,皮片成活率66.7%,余9例皮片成活面积〉75%;6例遗留创面感染,感染率22.2%;平均住院时间（19.7±8.3）d。对两组皮片成活率、创面感染率和平均住院时间进行比较,差异均有统计学意义（P〈0.05）。两组经换药或二次手术植皮后,撕脱创面均愈合。结论与常规敷料加压包扎技术比较,封闭负压引流技术可提高大面积皮肤撕脱伤创面植皮的成活率,降低感染率,缩短住院天数,是治疗大面积皮肤撕脱伤较为理想的方法。     

Closed suction drainage after orthopaedic surgery: evidence versus practice

Abstract Closed suction drainage systems are commonly used in orthopaedic surgery, particularly in joint arthroplasty. The rationale for the use of drains is a theoretical reduction of wound haematomas and infection. However the benefit of using drains after total hip or knee arthroplasty is controversial. Several reports have shown that the use of drains does not reduce infection and morbidity and is an unnecessary and potentially dangerous practice. In fact most studies highlighted that at best their use appears to make no difference to important clinical outcomes. Recently a metaanalysis raised the question about the usefulness of closed suction drainage again, concluding that it has no major benefits. The purpose of this study was to review the evidences available concerning the utility of closed suction drainage outlining that this practice is not supported by clinical evidence.     

负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损

目的 :探讨负压封闭引流技术(VSD)联合人工真皮治疗足踝部皮肤软组织缺损的临床治疗效果。方法 :自2011年1月至2013年12月间收治15例足踝部皮肤软组织缺损患者,其中男10例,女5例;年龄3~55岁,平均32.5岁;车祸伤8例,机器绞伤2例,碾压伤5例;单纯的肌肉软组织外露8例,肌腱外露2例,骨外露5例。清创后VSD覆盖创面并持续负压引,Ⅱ期待创面肉芽组织生长良好后用人工真皮覆盖创面,再次VSD覆盖创面并负压吸引,7~14 d后去除负压封闭引流,人工真皮上方移植游离皮片,无菌纱布加压包扎。结果 :所有患者获得随访,时间3~14个月,平均6.5个月。15例患者植皮片全部存活,人工真皮移植后植皮间隔时间为7~14 d,平均9.5 d。术后移植皮肤未见明显瘢痕增生及挛缩,无明显色素沉着,外观及功能恢复满意。结论:人工真皮植入后再行植皮传统的方法需2~3周,负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损,操作简单,明显缩短Ⅱ期植皮时间,无须皮瓣修复,供皮区损伤少,创面愈合质量高,临床效果满意。     

负压封闭引流结合敏感抗生素治疗假体周围急性感染

目的 :探讨负压封闭引流(vacuum sealing drainage,VSD)结合敏感抗生素治疗假体周围急性感染的疗效。方法:回顾性分析2012年3月至2018年12月采用保留假体的清创、VSD、敏感抗生素治疗11例假体周围急性感染,男7例,女4例;年龄58～88岁,平均72.5岁。髋关节假体周围感染8例,3例出现窦道,膝关节假体周围感染3例。结果:微生物培养阴性2例,阳性9例,金黄色葡萄球菌7例,其中2例耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA),表皮葡萄球菌2例。术后随访8～52个月,平均28个月,1例髋关节假体周围感染清创失败,清创距关节置换时间84 d,行II期人工关节翻修术。10例清创成功。末次随访时,髋关节假体周围感染清创成功患者Harris评分84.1(74～93)分;膝关节假体周围感染者膝关节协会评分(Knee Society score,KSS)84,84,89分。结论:膝关节置换术后1个月内,髋关节置换术后6周内假体周围急性感染,及服用抗凝药物引起假体周围出血伴急性感染,采用保留假...     

Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates

Background

The use of antimicrobial solutions for irrigation in appendicitis is controversial. Numerous antiseptic and antibiotic solutions have been suggested for use as an intraoperative irrigant. We sought to determine whether there was a difference in postoperative surgical site infections (SSIs) comparing normal saline (.9%), antiseptic solution (Dakin's, .25%), and an antibiotic solution (imipenem 1 mg/mL).

Methods

We performed a retrospective study of adult appendectomies from January 1997 through November 2007 at a single institution The data were evaluated by multivariate logistic regression analysis and chi-square test. The incidences of postoperative overall SSI, wound infection, and abdominal abscess were compared.

Results

A total of 1,063 cases were identified. Saline (n = 661) had an SSI rate of 9.8% (65/661), a wound infection rate of 7.3% (48/661), and an abdominal abscess rate of 4.2% (28/661). Dakin's (n = 208) had an SSI rate of 20.7% (43/208), a wound infection rate of 15.9% (33/208), and an abdominal abscess rate of 9.1% (19/208). Imipenem (n = 194) irrigation had an SSI rate of .5% (1/194), a wound infection rate of .5% (1/194), and an abdominal abscess rate of .5% (1/194).

Conclusions

These results suggest that abdominal irrigation with an antibiotic solution (imipenem 1 mg/mL) is superior to both normal saline and Dakin's solution.     

负压封闭引流治疗小鼠创面铜绿假单胞菌感染的效果及机制

目的 观察VSD对感染创面中铜绿假单胞菌生长的影响,并探讨其可能机制。 方法 选取健康成年雄性C57BL/6小鼠40只,按照随机数字表法分为对照组和治疗组,每组20只。无菌条件下切除各小鼠背部1 cm×1 cm的全层皮肤,将细菌荧光素酶目的基因luxCDABE标记的野生型铜绿假单胞菌菌株PAO1 -lux涂抹于创面,包扎创面24 h,制成铜绿假单胞菌感染小鼠模型。治疗组小鼠创面行VSD治疗（负压为-16.625 kPa）,对照组创面常规换药。分别于治疗前和治疗24 h时,用小动物活体成像系统检测2组小鼠创面PAO1-lux荧光强度,激光多普勒血流成像仪检测创面血流量,以实时荧光定量RT-PCR检测创缘组织IL-1β、血管内皮生长因子(VEGF)的mRNA表达水平。观察治疗24 h时2组小鼠创缘组织病理学特点。对实验数据行t检验。 结果(1)治疗前,治疗组小鼠创面PAO1 -lux荧光强度与对照组相近(t=0.03,P=0.98);治疗24 h时,治疗组的荧光强度为(2.69±0.75)光子·秒-1·厘米-2·单位角度-1(photons· s-1- cm-2·sr-1),明显低于对照组的(5.18±0.96)photons·s-1·cm-2·sr-1,t =3.54,P=0.02。(2)治疗前,治疗组小鼠创面血流量与对照组相似(t =0.50,P=0.64);治疗24 h时,治疗组创面血流量为(96±9)灌注单位,明显高于对照组的(70±11)灌注单位,t=3.13,P=0.04。(3)治疗前,2组小鼠创缘皮肤组织中IL-1β、VEGF mRNA表达水平接近（t=0.19,P=0.86;t=0.07,P=0.95）;治疗24h时,治疗组IL-1β、VEGF mRNA表达水平分别为4.72±0.37、2.68±0.39,均明显高于对照组的2.24±0.50、1.22±0.13,t值分别为6.90、6.12,P值均为0.00。(4)治疗24 h时,治疗组创缘皮肤组织内炎性细胞浸润数量较对照组增加约77％。 结论 与常规换药相比,VSD治疗在小鼠全层皮肤缺损早期即能明显降低创面铜绿假单胞菌含量。其机制可能与增加创面局部血流量、提高创面组织炎性细胞数量、促进IL-1β和VEGF的mRNA表达有关。     

Surgical site wound infection and wound pain after video-assisted thoracoscopy in patients with lung cancer: A meta-analysis

A meta-analysis was performed to comprehensively assess the effects of video-assisted thoracoscopy on surgical site wound infection and wound pain in patients with lung cancer. Studies on video-assisted thoracoscopy for lung cancer were collected from PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang database, from inception to January 2023. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Thirty-one articles with a total of 3608 patients were included, with 1809 in the video-assisted thoracoscopy group and 1799 in the control group. Compared with the control group, video-assisted thoracoscopy significantly reduced surgical site wound infection (odds ratio: 0.22, 95% confidence interval [CI]: 0.14–0.33, P < .001) and surgical site wound pain at postoperative day 1 (standardised mean difference [SMD]: −0.90, 95% CI: −1.17 to −0.64, P < .001) and postoperative day 3 (SMD: −1.59, 95% CI: −2.25 to −0.92, P < .001). Thus, these results showed that video-assisted thoracoscopy may have beneficial outcomes by reducing surgical site wound infection and pain. However, owing to the large variation in sample sizes and some methodological shortcomings, further validation is needed in future studies with higher quality and larger sample sizes.     

New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report

IntroductionNegative pressure wound therapy (NPWT) for abdominal surgical site infection (SSI) is becoming increasingly common, although enterocutaneous fistula (ECF) has been reported as a complication. To avoid ECF, we used computed tomography (CT) woundgraphy to evaluate the relationship between the wound and the intestine, and then safely treated the abdominal SSI with NPWT.Case presentationFollowing a laparoscopic intersphincteric resection for low rectal neuroendocrine tumor and covering ileostomy, a 59-year-old woman underwent stoma closure. Six days after surgery, we diagnosed SSI. We suspected ECF, because the wound was deep and the pus resembled enteric fluid. However, CT woundgraphy showed that the wound was separated from the abdominal cavity and the intestine by the abdominal rectus muscle. Accordingly, we performed NPWT. SSI was cured and the wound was well granulated. Twenty-three days after surgery, the patient was discharged. Eventually, the wound was completely epithelialized.DiscussionAlthough successful NPWT has been reported for open abdominal wounds, ECF is a common complication. ECF can be prevented by separating the wound from the intestine by the omentum or muscle fascia, protecting the intestinal serosa during surgery, and applying low vacuum pressure. The relationships among the wound, the fascia, and the intestine must be evaluated before abdominal SSI treatment. One good method is CT woundgraphy, which evaluates wound extent and depth, closure of muscle fascia, and the relationship between the wound and the intestine.ConclusionWe report a case of CT woundgraphy before NPWT for abdominal SSI. CT woundgraphy is a good candidate for evaluating wound condition.