不同方法治疗腹部手术切口脂肪液化的疗效对比及其影响因素分析

Different Methods for Abdominal Incision Fat Liquefaction and Their Risk Factors

目的探讨三种不同方法治疗腹部手术切口脂肪液化的临床疗效,分析腹部手术切口脂肪液化的影响因素。方法选取2010年1月—2012年1月重庆医科大学附属第一医院收治的腹部手术患者660例,其中手术切口发生脂肪液化60例(观察组),未发生脂肪液化600例(对照组)。观察组患者采用随机数字表法分为A组、B组和C组,每组各20例。A组采用简易封闭负压引流治疗;B组采用常规换药,重组人牛碱性成纤维细胞生长因子治疗;C组采用碘伏清洗,敷料敷于创面。观察三组患者的换药次数、切口愈合时间、住院时间。统计观察组和对照组患者的性别、年龄、疾病类型、基础疾病、腹壁脂肪厚度、手术类型、切口类型、使用高频电刀、手术时间、切口冲洗、关腹人员等资料。结果 A、B、C组患者换药次数、切口愈合时间、住院时间比较,差异均有统计学意义(P<0.05);A组患者换药次数、切口愈合时间、住院时间较B组和C组,C组较B组均明显减少,差异有统计学意义(P<0.05)。腹部手术切口脂肪液化与患者性别、年龄、疾病类型、手术类型、切口类型、手术时间均无关(P>0.05);与基础疾病、腹壁脂肪厚度、使用高频电刀、切口冲洗、关腹人员均有关(P<0.05)。结论采用简易封闭负压引流治疗腹部手术切口脂肪液化临床效果较好。基础疾病、腹壁脂肪厚度、使用高频电刀、切口冲洗、关腹人员等多种因素可导致腹部手术切口脂肪液化。

Objective To discuss the clinical effects of 3 different methods for abdominal incision fat liquefaction and their risk factors.Methods A total of 660 patients with abdominal surgery in our hospital from January 2010 to January 2012 were enrolled in this study.Thereinto,60 had fat liquefaction(study group),600 had not(control group).Study group were subdivided randomly into groups A,B,C,20 in each.Group A were given simple vacuum-assisted closure,group B given conventional dressing and recombinant human bovine basic fibroblast growth factor treatment(Rb FGF),group C given iodophor cleaning and a new medical dressing moist therapy.The frequencies of dressing changes,wound healing time,hospital stay were observed in groups A,B,C.Gender,age,disease types,underlying diseases,abdominal fat thickness,types of surgeries and incisions,use of high-frequency electric knife,surgical time,incision rinse,personnel doing abdominal closure and other information were calculated in groups study and control.Results There were significant differences in frequency of dressing changes,wound healing time,hospital stay between 3 groups(P<0.05);The frequency of dressing changes was lower,healing time and hospital stay shorter in group A than in groups B,C,and in group C than in group B,the difference was significant(P<0.05).Abdominal incision fat liquefaction was not associated with gender,age,types of diseases,surgeries and incisions,and surgical time(P>0.05),but with underlying diseases,abdominal fat thickness,use of high frequency electric knife,incision rinse,peronnel doing abdominal closure(P<0.05).Conclusion Simple vocuum-assisted closure is effective in treatment of abdominal incision fat liquefaction.Underlying diseases,abdominal fat thickness,use of high frequency electric knife,incision rinse,personnel doing abdominal closure and other varying factors lead to incision fat liquefaction.