慢性创面的治疗进展及创面外科整合治疗模式探讨

Progress in the treatment of chronic wound and discussion on the integrated surgical wound treatment mode

随着疾病谱的改变和社会老龄化的进展,慢性创面已逐渐成为威胁人类健康的主要疾病之一,也成为家庭和社会的主要经济负担之一。根据病因不同,慢性创面的发病机制不一,既有全身因素,也有局部因素的参与。慢性创面的治疗是一个多学科交叉的综合治疗过程,包含了内科治疗、外科治疗、血管介入治疗、富血小板血浆治疗和生物治疗等。每种治疗方案都有其适应证及优点和不足,制订治疗方案时,要根据患者创面情况选择多种方法联合治疗。传统的慢性创面治疗模式为多学科团队(MDT)治疗模式,需要介入科、整形外科、骨科等多个科室医师的参与,也是西方国家治疗慢性创面的主流模式。根据国内的医疗情况和笔者科室经验,笔者提出创面外科整合治疗(ISWT)模式,即把创面治疗的多项外科技术融合为一体的模式。与传统的MDT治疗模式相比,采用ISWT模式可以制订更合理的治疗方案,提高诊疗效率,缩短住院周期,同时也能提高团队的诊疗能力。随着慢性创面的发病率逐渐增高,ISWT模式有待进一步探索和完善,团队也需要更多专科人员的加入。

With the change of disease spectrum and the progress in the aging of society,chronic wound has gradually become one of the major diseases that threaten human health,and also one of the major economic burdens of family and society.According to the different etiology,the pathogenesis of chronic wound is different,including both systemic factors and local factors.The treatment of chronic wound is a multi-disciplinary integrated treatment process,including internal medicine treatment,surgical treatment,vascular interventional therapy,platelet-rich plasma treatment,and biological therapy,etc.Each treatment regimen has its own indications and pros and cons.To make a treatment regimen,a combination of a variety of options should be chosen according to the patient′s wound conditions.The traditional chronic wound treatment mode is multi-disciplinary team(MDT)treatment mode,which requires the participation of surgeons from multiple departments such as intervention department,plastic surgery department,orthopedics department,etc.,and it is also the mainstream mode for treating chronic wound in western countries.According to the domestic medical situation and the experience of our department,we put forward the integrated surgical wound treatment(ISWT)mode,that is to integrate multiple surgical techniques of wound treatment.Compared with the traditional MDT treatment mode,to apply the ISWT mode can make a more reasonable treatment plan,improve the efficiency of diagnosis and treatment,shorten the hospitalization period,and improve the diagnosis and treatment ability of the team.With the increasing incidence of chronic wound,the ISWT mode needs to be further explored and improved,and the team needs more specialized experts to join in.