老年结直肠肿瘤患者术后切口裂开18例分析

Clinical analysis of surgical incision dehiscence in 18 elderly patients with colorectal tumor

目的观察18例老年结直肠肿瘤患者术后切口裂开的临床治疗效果及经验分析。方法回顾性分析2015年1月至2017年12月,解放军第309医院住院并发切口裂开的18例老年结直肠肿瘤患者,对其身体质量指数(BMI),基础疾病情况及切口裂开的时间,裂开的范围及处理措施进行观察。结果 18例患者中有16例(88.9%)合并糖尿病,14例(77.8%)合并慢性支气管炎或者慢性阻塞性肺疾病(COPD);11例(61.1%)合并低蛋白血症。17例患者(94.44%)是合并多因素的患者,仅有1例(5.56%)是由于单一疾病导致的切口裂开。6例因切口裂开较大,急诊行清创及减张缝合术,余12例予以保守内科换药治疗,所有患者均痊愈出院。结论肥胖、血糖、营养状态和肺部的疾病是导致老年患者术后切口裂开的主要因素。一旦出现切口裂开,除非出现肠管暴露,保守治疗是安全有效的。

Objective To discuss the therapeutic experience of Surgical Incision Dehiscence in 18 elderly patients with colorectal tumor. Methods A Retrospective study was made on 18 cases treated in the 309 th Hospital of PLA between January 2015 and December 2017. The body mass index（BMI） value, the basis diseases and the time of surgical incision dehiscence, the scope of the split and the treatment measures were observed. Results Of the 18 patients, 16（88.9%） had diabetes; 14（77.8%） had chronic or chronic obstructive pulmonary disease（COPD）; 11（61.1%） was associated with hypoproteinemia. 17 patients（94.44%） had multiple factors. Only 1 case（5.56%） were caused by single factor. 6 cases were treated with debridement and tension reduction suture because of large incision dehiscence. The remaining 12 cases were treated by conservative treatment. All patients were cured and discharged. Conclusion Obesity, blood sugar, nutritional status and lung diseases are the main factors which lead to surgical incision dehiscence in elderly patients. Once the surgical incision dehiscence happened, conservative treatment is safe and effective unless there is intestinal tube exposure.