后腹腔镜术后穿刺孔延迟愈合的处理(附25例报告)

Treatment for Delayed Union of Puncture Hole After Retroperitoneal Laparoscopic Operations(Report of 25 Cases)

目的:探讨后腹腔镜术后穿刺孔延迟愈合的处理措施。方法:回顾性分析2003年1月～2008年12月行后腹腔镜肾脏及肾上腺手术患者689例的临床资料:术后发生穿刺孔延迟愈合25例,占3.63%。其中单纯伤口闭合不良12例,腹壁窦道形成8例,后腹腔皮肤瘘形成5例。运用湿性愈合方法处理单纯伤口闭合不良;使用带侧孔探针注生理盐水冲洗腹壁窦道;采用生理盐水特制棉签擦洗后腹腔皮肤瘘。清创期窦道伤口使用条状美盐(mesalt),每天换药1次,连续使用1～5天,伤口分泌物减少,过渡到肉芽增生期,窦道深度小于3cm,根据渗出物的多少选择藻酸盐类或水胶体糊剂填塞伤口,换药间隔3～5天。1例后腹腔皮肤瘘伴脓肿患者采用封闭式负压引流(VAC)辅助伤口愈合,4～6天换药1次。结果:5～10天,单纯闭合不良伤口愈合;10～15天,腹壁窦道伤口愈合;20～32天,后腹腔皮肤瘘伤口愈合。结论:湿性愈合适用于后腹腔镜术后穿刺孔延迟愈合,尤其是深腔和窦道感染伤口,是需要填补缺损的延期愈合伤口的标准非手术愈合方式。正确地评估伤口,并根据评估结果准确选择伤口敷料可缩短炎症期,缩短伤口愈合时间。美盐有利于坏死组织溶解与吸收,促进伤口清创,缩短炎症期过程,加速伤口愈合。

Objective：To discussed the treatment for delayed union of puncture hole after retroperitoneal laparoscopic operations. Methods：January 2003 to December 2008, 689 cases of retroperitoneal laparoscopic operations about kidney and adrenal gland were analyzed retrospectively. Postoperative delayed union of puncture occurred in 25 cases （3.63%）, in which simple malocclusion represented in 12 cases, sinus in abdominal wall formed in 8 cases, fistula between retroperitoneal cavity and skin formed in 5 cases. Moist wound healing measurements were used to process delayed union. Sinus wounds were douching with physiological saline through catheter with lateral aperture. Wounds of fistula were scrubed with specially made cotton buds using physiological saline. In stage of debridement, mesah was used for sinus wounds one time every day. After 1 to g days, wound secretion decreased and changed into the stage of granulation proliferation. In this stage, the depth of sinus tract was always less than 3 cm, alginates or hydrocolloid pastes were used to packing wounds according to the exudation every 3 to 5 days. VAC was used to assist wound healing in 1 case of fistula between retroperitoneal cavity and skin accompanying abscess, and frequency of changing dressings was every 4 6 days. Results： The wound healing time of simple malocclusion was 5-10 days, the time of sinus was 10 15 days and the time of fistula between retroperitoneal cavity and skin was 20-32 days. Conclusions： Moist wound healing measurement is standard non operative mode for de- layed union requesting supplying deletion, applying to delayed union of puncture hole after retroperitoneal laparo- scopic operations, especially to deep cavity and sinus accompanying infection. Inflammation stage and wound healing time can be shortened by exactly assessment and selection of wound dressing according to the result of assessment. Mesalt is in favour of histolysis and resorption of necrotic tissue, can be used to promote wound debridement, shorten process of inflammation stage and accelerate wound healing.