负压封闭引流技术在颈部巨大恶性肿瘤手术中的应用

Application of vacuum sealing drainage on the defect of large neck neoplasms after surgical procedures

目的探讨负压封闭引流技术（VSD）在治疗颈部巨大恶性肿瘤术后缺损创面中的疗效及价值。方法对15例侵犯皮肤的颈部巨大恶性肿瘤行肿瘤根治术,应用VSD覆盖创面（治疗组）。术后持续给予6.65~7.98 mmHg负压引流72h,然后改用间歇负压治疗（负压治疗5min,间歇2min）。术后7~14d停止负压封闭引流,如创面肉芽组织生长良好行创面植皮术,肉芽组织生长不良则再次行VSD覆盖创面治疗1周后,行创面植皮术。另选取9例患者作为对照组,行颈部肿瘤切除加游离组织瓣移植治疗。结果治疗组的手术时间为2~4h,平均3h;出血量为300~800ml,平均500ml。对照组的手术时间为4~8h,平均6h;出血量为500~1200ml,平均800ml。治疗组15例患者共接受17例次VSD创面治疗,经治疗后创面新鲜肉芽组织生长良好,并完全覆盖颈动脉等重要组织结构,术后1~3周创面顺利植皮,植皮愈合率为94.7%。对照组中1例出现移植皮瓣坏死。结论 VSD用于颈部巨大肿瘤术后缺损创面的治疗具有操作简单、减少交叉感染、促进创面愈合、患者易耐受等优点,是一种治疗颈部巨大恶性肿瘤术后缺损有效且安全的方法。

Objective To evaluate the efficacy of vacuum sealing drainage（VSD） in the surgical management of large neck neoplasms.Methods Fifteen patients with neck malignancies（treatment group） were treated with radical surgery,and the wounds were applied with VSD.The drainage tubes were connected with vacuum bottle（negative pressure of 6.65-7.98 mmHg） for 72 hours.Then the intermittent negative pressure was used（every 5 minutes with 2 minutes interval）.Seven to fourteen days after surgery,VSD was removed.Wounds with good granulation tissue were treated with skin graft surgery;wounds with poor granulation tissue were treated with VSD 1week again,and then skin grafting was operated.The 9 patients of control group were treated with tumor resection and free tissue flap transplantation.Results In treatment group,time of surgery was about 2-4h with 3h at average and the amount of bleeding was 300-800ml with 500ml at average.Time of surgery was about 4-8h with 6h at average and the amount of bleeding was 500-1200ml with 800ml at average in control group.Fifteen patients received a total of 17 cases of sub-VSD wound treatment in treatment group.After the treatment,the growth of wound granulation tissue was good,and the carotid artery and other important organizational structure were completely covered.Skin grafted was applied in 1-3 week after surgery,and healing rate was 94.7%.One skin grafting flap necrosed in control group.Conclusion With the advantages of easy operation,less cross infection,fast healing and good tolerance,VSD is a safe and effective method for large neck neoplasms.