创面功能性敷料引流及皮肤吻合器对胆道术后感染切口愈合能力的影响

目的探讨使用创面功能性敷料引流和皮肤缝合器对胆道手术后感染切口愈合能力的影响。方法45例发生术后切口感染的剖腹胆道手术患者,根据处理方法的不同分为观察组(22例)和对照组(23例)。观察组的感染切口清创后使用护创液纱条引流联合一次性使用皮肤吻合器治疗,对照组在清创后采用0.9%氯化钠溶液纱条引流,感染控制后间断缝合手术切口。比较两组的感染切口愈合情况、局部或全身不良反应情况和随访复查情况。结果观察组患者的切口红肿及渗出消退时间、切口二次缝合时间和创面完全愈合时间均短于对照组,差异有统计学意义(P<0.05)。观察组86.4%的患者切口愈合外观较为平整、美观,瘢痕增生少,与对照组(56.5%)比较,差异有统计学意义(P<0.05)。两组的局部或全身不良反应发生率比较,差异无统计学意义(P>0.05)。两组患者均接受术后随访5~12个月,随访期间均未发现切口再感染、裂开、切口疝等并发症。结论胆道术后感染切口清创后使用护创液湿敷引流能够有效提高切口的愈合能力,感染控制后使用皮肤吻合器无创关闭手术切口,有利于加速切口愈合。

Objective To investigate the effect of functional wound dressing drainage and skin suturing device on the healing ability of infected incision after biliary surgery.Methods 45 patients with postoperative incision infection undergoing open biliary surgery were divided into observation group(22 cases)and control group(23 cases)according to different treatment methods.After debridement,the infected incision in the observation group was treated with wound protection fluid gauze drainage combined with disposable skin stapler.The control group was treated with 0.9%sodium chloride solution gauze drainage after debridement,and the surgical incision was sutured intermittently after infection control.The wound healing,local or systemic adverse reactions and follow-up were compared between the two groups.Results The time of incision redness,swelling and exudation subsided,the time of incision secondary suture and the time of complete wound healing in the observation group were shorter than those in the control group(P<0.05).86.4%of the patients in the observation group had smooth and beautiful incision healing and less scar hyperplasia.There was statistically significant difference compared with the control group(56.5%)(P<0.05).There was no statistically significant difference in the incidence of local or systemic adverse reactions between the two groups(P>0.05).Both groups were followed up for 5~12 months.No complications such as incision reinfection,dehiscence and incision hernia were found during the follow-up.Conclusion After debridement of postoperative infection incision of biliary tract,wet compress and drainage with wound protection fluid can effectively improve the healing ability of incision.After infection control,non-invasive closure of surgical incision with skin stapler is helpful to accelerate incision healing.