腹部切口脂肪液化的防治体会

目的切口脂肪液化是腹部手术后较为常见的并发症,预防其发生就成了外科临床工作的首要任务。方法在缝合皮下脂肪层前用大量生理盐水冲切口。脂肪液化的治疗的原则是对于渗出液较少时不主张暴露全部切口,采用间断地位拆线1～2根,局部敞开外加10%高渗盐水引流效果较好,渗出液较多或者渗出范围较广时必须敞开切口,通畅引流,预防应用抗生素,高渗盐水纱条或者庆大霉素纱条全切口引流,待新鲜肉芽组织形成后行二期缝合。结果皮下脂肪≤2 cm的干预组切口脂肪液化率差异无统计学意义,P﹥0.05;皮下脂肪≤2 cm的对照组的脂肪液化率与皮下脂肪≥4 cm的对照组的脂肪液化率差异有统计学意义,P﹤0.01;皮下脂肪≥4 cm的干预组切口脂肪液化率差异有统计学意义,P﹤0.01。结论术前使血糖控制在10 mmol/L,纠正贫血与低蛋白血症;术中正确使用高频电刀,用低强度电流切割皮下组织,在切割脂肪组织时力求准确、迅速,避免反复切割及长时间接触脂肪组织;在缝合皮下脂肪层前用大量生理盐水冲切口。

Study on the Prevention and treatment of fat liquefaction of abdominal incision

OBJECTIVE Fat liquefaction of abdominal incision is the more common complications after abdominal surgery,and the main surgery task is to prevent the occurrence of fat liquefaction.METHODS We washed the incision with large amounts of physiological saline before closure of subcutaneous fat.The treatment principle of fat liquefaction was not to expose all of the incision when less exudates;Open local Incision with an additional 10% hypertonic saline drainage can achieve good results;Incision open,unobstructed drainage and use of antibiotics are necessary when more exudates or exudative a wider range;The whole incision drainage used hypertonic saline or gentamicin gauze.Two stage suture was implemented when the fresh granulation tissue was formed.RESULTS The fat liquefaction rate of the experimental group did not show significant difference compared with the control group when Subcutaneous fat thickness was less than 2cm(P﹥0.05);The fat liquefaction rate of the control group(Subcutaneous fat thickness was less than or equal to 2cm)was significantly different compared with the control group(less than or equal to 4cm)(P﹤0.01);The fat liquefaction rate of the experimental group was significant difference compared with the control group(Subcutaneous fat thickness was more than or equal to 4cm)(P﹤0.01).CONCLUSION Effective measures should be taken to prevent the fat liquefied,including preoperative to correct anemia and hypoproteinemia,controlling blood glucose below than 10 mmol/L,proper use of electrotome,low-current cutting subcutaneous tissue,accurately and quickly cutting the fat tissue,so as to avoid repeated cutting and prolonged exposure of fat tissue,washing incision with large amounts of physiological saline before closure of subcutaneous fat.