难治性腹壁深部手术部位感染的确定性手术治疗

Surgical treatment of patients with refractory deep surgical infection of abdominal wall

目的探讨慢性腹壁深部手术部位感染的手术治疗的方法。方法12例腹腔手术患者发生深部手术部位感染,经换药或清创缝合仍未愈合,平均(15±3.2)个月。我们采取确定性手术整块切除腹壁窦道和瘢痕化窦道,全层腹壁间断一层缝合。结果11例切口一期愈合,1例发生浅部手术部位感染,经换药愈合,平均随访16个月(6个月至4年),无感染或切口疝发生。结论腹壁切口窦道切除、腹壁间断全层缝合是治疗难治性腹壁深部手术部位感染的有效方法。

Objective To illustrate an approach to the management of refractory deep surgical infection of the abdominal wall. Methods Twelve patients suffered from deep surgical infection following abdominal surgery. Infective incisions did not completely heal for 15 ± 3.2 months after changing dressings or debridement and suturing. The patients were treated with radical en bloc excision of sinus tracts and scarred fascia followed by whole layer interrupted sutureing. Results Wounds of 11 patients healed without re-infection. One patient developed superficial infection but healed after change of dressings. No recurrence of infection nor occurrence of hernia was observed during follow-up （range, 6 - 48 months）. Conclusions Surgical treatment by radical en bloc excision of sinus tracts and scarred fascia followed by whole layer interrupted sutureing is an effective method for management of refractory deep incisional infection of the abdominal wall.