防治肛周开放性创口感染持续负压封闭吸引改良技术的临床研究

Clinical study on efficacy of modified continuous vacuum sealing drainage on the prevention and treatment of perianal infections of open wounds

目的评估改良持续负压封闭吸引术在防治肛周创口感染中的临床疗效,为肛周开放性创面的治疗开拓新的治疗途径。方法选择2012年6月-2013年12月61例急诊肛周创伤患者为研究对象,随机分为两组,所有患者均行术中探查及彻底清创缝合,在此基础上,对照组31例患者采取常规换药法,治疗组30例患者应用持续负压封闭吸引(VSD)技术进行治疗,观察比较两组患者术后两周创口感染的主要评价指标及疗效。结果手术后两组患者在血沉、C-反应蛋白、白细胞计数、体温、抗菌药物使用时间、创口愈合时间及住院时间等方面比较均较治疗前明显改善,治疗组较对照组改善更明显,差异均有统计学意义(P<0.05);治疗组和对照组患者术后创口感染率分别为6.7%和19.4%,治疗组和对照组需行人工肠造口二期手术的概率分别为3.3%和12.9%,两组比较,治疗组低于对照组,差异均有统计学意义(P<0.05)。结论改良持续负压封闭吸引技术可降低肛周创口感染率,同时降低行人工肠造口二期手术概率,可在临床推广应用。

OBJECTIVE To evaluate the efficacy of modified continuous vacuum sealing drainage on the prevention and control of the perianal open wound infections so as to develop new therapeutic approaches .METHODS From Jun .2012 to Dec .2013 ,a total of 61 cases of patients suffered from perianal trauma were randomly divided into two groups .All patients were treated with probe during surgery and their wounds were cleared and sutured thor‐oughly .On the basis of this ,31 patients in the control group were adopted regular medication and the treatment group （30 cases） was applied continuous vacuum sealing drainage .The major evaluating indicators of wound infec‐tion and efficacy of the two groups after two weeks of treatment were compared .RESULTS The two groups of pa‐tients after surgery improved significantly in the erythrocyte sedimentation rate ,C‐reactive protein ,white blood cell count ,fever ,time of antibiotic use ,time of wound healing and length of hospital stay and the treatment group got a even better efficacy .The differences were significant （P〈0 .05） .The wound infection rates were 6 .7% ,19 .4% respectively in the treatment group and the control group .The probability of undergoing stage II sur‐gery of artificial enterostomy in the two groups was 3 .3 % and 12 .9% respectively .The differences between the two groups were significant （P〈 0 .05） .CONCLUSION Modified continuous VSD can reduce rate of perianal wound infections and decrease the possibility of stage II surgery of artificial enterostomy .Hence it can be applied in clinic .