封闭式负压引流治疗内脏暴露且难以短期缝合的腹壁切口全层裂开的处理经验

Negative pressure wound therapy for full-thickness wound dehiscence associated of internal organs exposure and abdominal wall difficult to be sutured:a case report

目的报道采用封闭负压引流处理腹壁切口裂开小肠暴露的临床经过和治疗经验。方法 60岁男性患者因肾周脂肪肉瘤,外院行脂肪肉瘤切除+左肾切除+结肠切除,术后吻合口漏加做结肠造瘘。入院时腹腔感染、腹壁切口全层裂开并脏器暴露、皮下脓肿、感染性休克、全身多器官功能不全,在规范的全身系统治疗的基础上,使用改良的封闭式负压引流术,回收腹部渗液、保护外露脏器、保护术口周围的皮肤和治疗术口感染;在治疗过程中出现小肠瘘的并发症,通过在小肠内置入内引流管、硅胶封堵和负压引流,治疗小肠瘘的并发症,使患者能够不依靠肠外营养而生存;9月后行手术成功切除小肠瘘。结果患者全身感染症状、内环境及小肠功能在1个月之后好转,逐渐缝合术口。新出现的小肠瘘的并发症,依靠小肠内引流管和负压引流,患者可不依靠肠外营养支持生存,等待二次手术时机。9个月后手术切除小肠瘘,术口完全愈合。结论封闭式负压引流可用于严重的腹腔感染后难以短期缝合的术口全层裂开的治疗。

Objective To report the clinical experience and experience of treatment of abdominal incision dehiscence of small bowel by vacuum sealing drainage. Methods A 60-year-old male patient who suffered from perirenal liposarcoma,underwent resection of perirenal liposarcoma,left nephrectomy liposarcoma and colon resection. After the first operation,the patient underwent colostomy because of complication postoperative anastomotic leakage. When this patient was admitted to our hospital,he had abdominal infection,abdominal incision dehiscence associated with viscera exposure,subcutaneous abscess,septic shock and multiple organ dysfunction. Combined with standard systemic treatment,negative pressure wound therapy(NPWT) recovered abdominal exudate,protected exposed organs,protected surrounding of skin incision and treated incision infection. New complications of small bowel fistula occurred during treatment. The complication of small intestinal fistula was treated by internal drainage tube,silica gel block and NPWT in the small intestine Results Patient s symptoms of systemic infection,internal environment and intestinal function were gradually improved after one month.Then the incision was gradually suture. The complications of the new small intestinal fistula were treated by small intestinal drainage tube and negative pressure drainage. After 9 months without parenteral nutrition,the patient underwent surgical resection of small intestine fistula. Conclusion NPWT can be used for treatment of full-thickness wound dehiscence associated symptoms of internal organs exposure,abdominal wall difficult to be sutured within short time and severe abdominal infection after operation.