经脐单孔腹腔镜胆囊切除术后切口感染预防策略

目的 观察新的预防方案对经脐单孔腹腔镜胆囊切除术后切口感染的预防效果.方法 经脐单孔腹腔镜胆囊切除术患者57例随机分为观察组31例和对照组26例.观察组切口感染预防措施：术前24 h常规备皮后应用双氧水消毒,安尔碘消毒两遍,最后放置安尔碘棉球于脐部至手术开始;麻醉诱导前半小时预防性应用头孢西丁钠2.0g;切口缝合前应用庆大霉素生理盐水清洗切口;术后24 h换药,术后72 h第2次换药并拆线出院.对照组按照传统措施进行防感染处理.分别于术后12、24、36、48、60、72 h检测两组体温、WBC、中性粒细胞比率（GR）,观察切口局部有无红肿热痛症状,统计两组切口感染发生率.结果 对照组术后24、36、48、60h体温高于观察组,术后24、72 h WBC高于观察组,术后24、72 h GR高于观察组（P均＜0.05）.观察组术后体温、WBC、GR较术前略升高,但无统计学意义,对照组体温、WBC、GR较术前升高（P均＜0.05）.观察组无切口感染（0％）,对照组2例（7.7％）,两组切口感染发生率相比,P ＜0.05.结论 用新预防方案即术前应用双氧水、安尔碘消毒、麻醉诱导前预防性应用抗生素、调整术后换药时间可降低经脐单孔腹腔镜胆囊切除术后切口感染发生率.

Strategy to prevent wound infection of single-incision laparoscopic cholecystectomy

Objective To evaluate the effects of new strategies to prevent the wound infections in patients undergoing single-incision laparoscopic cholecystectomy （SILC）.Methods Fifty-seven patients undergoing SILC were randomly divided into two groups：31 patients for group A （experimental group） and 26 patients for group B （control group）.Group A：24 h before surgery,patients were flushed with 3％ oxydol solution after shaving then disinfected with Anerdian twice,we placed an Anerdian tampon on the naval until surgery started,then we prophylactically used 2.0 g cefoxitin sodium half an hour before anesthesia induction,cleaned the incision with gentamicin saline before suture,and dressingly changed 24 h after surgery,72 h after surgery we took the stiches out and the patients were discharged.Group B：we used the conventional disinfection strategies.The temperature and WBC,neutrophil ratio （GR） of all patients were recorded at 12,24,36,48,60 and 72 h after surgery,meanwhile,the infection symptoms were observed and incision infection rates in both group were recorded.Results The postoperative body temperature of patients at 24,36,48,60 h in group B were higher than those of group A,the WBC and GR at 24,72 h after surgery in group B were higher than those of group A （all P ＜0.05）.We compared the body temperature,WBC,GR of group A preoperatively and postoperatively,they were slightly higher after surgery,but the difference was not statistically significant; for group B,the temperature,WBC,GR were higher postoperatively （all P ＜ 0.05）.No incision infection in group A （0％） while 2 cases happened in group B （7.7％）,the difference of incision infection rate was statistically significant between two groups （P ＜ 0.05）.Conclusions The new strategies by disinfecting with oxydol solution,Anerdian,using prophylactic antibiotics before anesthesia induction and adjusting dressing change time might reduce the incision infections after transumbilical single-incision laparoscopic cholecystectomy.