老年患者开腹手术后切口裂开处理的再认识(附11例报告)

Refined treatment of abdominal incision dehiscence after abdominal surgery: Report of 11elderly cases

目的：探讨老年人开腹手术后，腹腔高压切口裂开，腹腔开放膨出肠管的处理方法。方法：采用碘伏纱条沿腹壁切口插入腹腔，围成一个形似栅栏圈包装肠管，在肠管与腹壁之间构成一个屏障，于左右结肠旁沟碘伏纱条外放置一根多孔引流管接负压引流；栅栏圈上方置碘伏纱布，开放切口棉垫包裹覆盖，最外层用手术贴膜封闭，多头腹带固定。结果：11例患者均未出现肠瘘，7～9d行确定性关腹，病人痊愈出院。随访1～4年，饮食正常、大便通畅，无切口疝。结论：老年人开腹手术后，切口裂开多伴有腹腔高压。采用损伤控制技术开放腹腔，可有效缓解腹腔高压；碘伏纱条围成的栅栏圈，有良好的虹吸引流和消炎杀菌作用，辅以负压引流有助于确定性关腹，具有安全有效、操作简便、取材方便和并发症少的优点。

Objective：To investigate the treatment of abdominal hypertension incision dehiscence after abdominal surgery in elderly patients .Methods：Iodophor sliver was put into the abdominal cavity along the abdominal incision as a shape of fence circle .Bulging bowel was packed to form a barrier be-tween the bowel and the abdominal wall.A multi-pole drainage pipes was laid in colon groove to decrease tension.The incision fence was covered with io-dophor gauze.The incision was overlapped with cotton cushion,closed with surgical membrane and fixed with long cummerbund.Results：Eleven patients were not found to develop postoperative fistula.Their incisions were sutured in seven or nine days and all healed .After one to four years of follow-up,they recovered to normal diet and smooth stool without incisional hernia .Conclusion：The elderly patients normally produce abdominal hypertension after opera-tion.The damage controlling method can reduce the tension.Iodophor sliver exerts siphon and drainage effect.The drainage pipe is helpful for closure of the incision.This treatment is a safe,effective and simple method with less complication .