预防急性阑尾炎并腹膜炎手术切口感染的疗效分析

Clinical Analysis of Wound Infection after Appendectomy in Patients with Acute Appendicitis Complicated with Peritonitis

目的探讨降低急性化脓性阑尾炎并腹膜炎病人手术切口感染几率的方法。方法将217例化脓性阑尾炎并腹膜炎病例分为穿孔性阑尾炎并腹膜炎(A组)114例,非穿孔性阑尾炎并腹膜炎(B组)103例,其中A组放置腹腔引流79例,未放置引流35例;B组放置腹腔引流42例,未放置引流61例,分析统计两组切口感染率。结果本组病例切口感染率为(10/217)4.61%,其中A组切口感染率(9/114)7.89%,B组切口感染率(1/103)0.79%(P<0.05)。A组放置引流切口感染率为(8/79)10.13%,未放置引流切口感染率为(1/35)2.86%(P<0.05)。放置引流切口感染率A组(10.13%)与B组(3.23%)相比较,差异有统计学意义(P<0.05)。结论急性化脓性阑尾炎并腹膜炎手术切口感染与腹膜炎严重程度有关,早诊断、早手术、避免误诊,术中严格无菌操作,掌握抗生素使用指征可减少切口感染几率,放置引流与否应视病人个体而定。

Objective To prevent wound infection after apendectomy in patients with acute septic appendicitis complicated with peritonitis. Methods 217 patients with acute septic appendicitis complicated with peritonitis were randomly divided into two groups： 114 perforative appendicitis cases （group A） and 103 non-perforative cases （group B）. The number of subjects with abdominal cavity drainage in group A and group B was 79 and 42, respectively. The incidence of wound infection in these two groups was analyzed. Results The rate of wound infection was 4.61% （ 10/ 217）, in which 7.89%（9/114）was in group A and 0.79%（1/103）was in group B （P〈0.05）. In group A, the infection rate in the subjects with and without abdominal cavity drainage was 10.13% （8/79）and 3.23% （1/31;P〈0.05）, respectively. In group B, the infection rate in the subjects with abdominal cavity drainage was 3.32% （1/31, P〈0.05）. Conclusion In patients with acute septic appendicitis appendicitis, disease severity is associated with wound infection. The key to prevent wound infection after appendectomy is early diagnosis and operation, using aseptic technique in operation and the proper use of antibiotics. Abdominal cavity drainage should only be used when it is required.