预防骶神经调节术围手术期及术后切口局部感染的经验初探

Initial experiences of preventing local incision infection during sacral neuromodulation

目的 初步探讨骶神经调节术（SNM）围手术期综合抗感染方法能否预防围手术期及术后感染的发生.方法 回顾性分析2013年1月至2015年2月在北京朝阳医院应用SNM治疗的23例顽固性下尿路功能障碍患者（男11例,女12例）的资料.围手术期（Ⅰ期及Ⅱ期）采用全面、彻底的皮肤消毒、严格无菌操作、至少24h静脉滴注抗生素（头孢西丁或左氧氟沙星）预防性应用、术中大量无菌蒸馏水冲洗及后续口服抗生素补充的综合性抗感染措施预防切口局部感染,同时观察术后体内电极头、延长线接头及局部组织感染发生率,并总结相关经验.结果 23例患者均在局麻下接受了SNM Ⅰ期手术,平均手术时间1.5h,平均住院时间3.2d,电极植入体验时间平均37.1 d.所有患者Ⅰ期测试结束时均无临床意义的局部感染征象出现,切口均为Ⅰ/甲标准愈合.8例患者因疗效不佳于Ⅰ期测试结束后在局麻下实施电极拔除,此8例患者拔除电极及体内延长线接头的细菌培养结果均为阴性,且电极组件拔除术后伤口均为Ⅰ/甲标准愈合.15例患者接受Ⅱ期永久刺激器（IPG）植入,手术于局麻下完成,平均手术时间63 min,平均住院时间2.2d,其中10例患者取出体内延长线接头后进行了细菌学培养,结果均为阴性,所有Ⅱ期手术患者伤口均为Ⅰ/甲标准愈合.结论 围手术期的综合性抗感染措施能有效预防SNM术后切口局部感染的发生。

Objective To explore the possibility of using comprehensive anti-infection method during sacral neuromodulation （SNM） operation to prevent postoperative loacal incision infection.Methods SNM were performed for 23 patients （male 11 cases,and female 12 cases） who had intractable lower urinary tract dysfunctoin from January 2013 to Feburary 2015.During the treatment period （both in stage Ⅱ and stage Ⅱ）,several steps were adopted to prevernt local incision infection after opertion,such as comprehensive skin disinfection,strict aseptic operating,intravenous infusion of antibiotics （cefoxitin or levofloxacin） prophylacticly at least 24 h,using sterile water to wash the incison in operation and taking oral antibiotics anti-infection as supplemental after operation.At the meantime,microbiological examination was performed in the explanted tined leads,extension wire connection and local gluteal tissue.Results A total of 23 patients received SNM with local anesthesia,mean time of operation,hospitalization and test period were 1.5 h,3.2 d and 37.1 d,respectively.All patients had no symptoms of clinical local infection after stage Ⅰ test period and all incisions were healing with Ⅰ/A standard.Eight patients were removed the inside electrodes because of poor effect at the end of test period with local anesthesia.Bacterial growth was not detected in all 8 patients of explanted tined leads and extension wire connection.And all 8 patients had their incision healed with Ⅰ/A standard.Fifteen patients received implantable pulse generator（IPG） with local anesthesia.Mean time of operation was 63 min and mean time of hospitalization was 2.2 d.Among them,10 patients＇ extension wire connection and loacal tissue were send to microbiological examination and no bacterial growth was found.All stage Ⅱ incisions were healing with Ⅰ/A standard.Conclusion Perioperative comprehensive anti-infection method could prevent local incision infection after SNM.