脊柱手术患者切口感染的危险因素分析

目的研究脊柱手术患者切口感染的危险要素,给临床治疗切口感染带来借鉴依据。方法通过回顾性分析2014年8月-2016年8月期间180例进行脊柱手术治疗的患者病历信息,统计研究切口感染的具体因素。结果在接受了脊柱手术之后7例出现了不同状况的切口感染,其总出现率是3.9%。脊柱手术之后患者切口出现感染的影响因素包括:年龄、糖尿病、脊柱手术史、手术时间、手术过程出血量、手术时间等。结论脊柱手术患者的切口感染是通过一系列因素造成的,临床要采用有效的干预方式来进一步减少脊柱手术患者切口感染的发生率。

PEG与常规手术胃造瘘的疗效及术后造瘘口感染发生率比较

目的研究经皮内镜下胃造瘘术(PEG)与常规手术胃造瘘的疗效及术后造瘘口感染发生率。方法抽选2014年5月—2015年5月在我院接受胃造瘘术的患者96例,按照治疗方式不同分为PEG组(n=51)和常规组(n=45),PEG组行经皮内镜下胃造瘘术,常规组行传统手术胃造瘘术。记录两组患者手术时间、术中出血量、术后管饲时间及住院时间;观察术后并发症发生情况,计算对比术后造瘘口感染发生率。结果 PEG组手术时间(29.32±7.15)min、术后管饲时间(24.65±1.71)h及住院时间(24.82±7.61)d与常规组比较均显著较短,差异有统计学意义(P<0.05)。两组术中出血量比较无显著差异(P>0.05)。PEG组术后造口感染发生4例(5.63%)、瘘管脱落0例(0.00%)与常规组10例(22.22%)、4例(8.89%)比较显著较低,并发症总发生率13.73%显著低于常规组44.44%,差异有统计学意义(P<0.05)。结论 PEG较常规手术胃造瘘术手术时间短、术后管饲时间快、并发症少,为安全、方便、快捷、有效的手术方式。

MEBO配合医用微波仪理疗在感染手术切口中的疗效观察

目的:探讨MEBO配合医用微波仪(YWY-2T)在处理骨外科、妇产科手术后术口感染、坏死、裂开、脂肪液化等方面的疗效。方法:将68例患者随机分为观察组和对照组各34例,68例创面均给予清创、切除失活组织、清除液化组织等处理,均用医用微波仪对术口(隔着纱布)进行理疗,时间约20～30min。观察组用MEBO湿润纱条填塞包扎,每日2次。对照组用凡士林纱条填塞,观察两组的创面愈合时间、疼痛程度、愈合后的外观状态等。结果:观察组平均愈合时间明显缩短,创面疼痛明显减轻,外观理想,无明显疤痕,缩短了住院时间。结论:MEBO配合医用微波仪在处理骨外科、妇产科手术后术口感染、坏死、裂开、脂肪液化等方面,能明显控制感染,改善局部血运,促进肉芽组织生长及皮肤再生,明显缩短创面愈合时间,提高治愈率,减少疤痕形成,疗效安全可靠,值得临床推广应用。

湿润烧伤膏治疗感染伤口的临床疗效观察

目的:观察湿润烧伤膏(MEBO)治疗感染伤口的临床疗效。方法:82例患者感染伤口应用湿润烧伤膏治疗。结果:82例患者全部愈合,治愈率为100%。愈合创面平整,无挛缩畸形,无明显功能障碍。结论:湿润烧伤膏治疗手术切口感染有较好的治疗效果。

护理干预对先天性巨结肠术后肛门吻合口感染及肛周皮炎的影响

针对先天性巨结肠术后肛门吻合口感染及肛周皮炎患者,分析对其实施护理干预的效果。方法:在2019年5月-2020年5月期间随机选取我院儿科临床确诊的先天性巨结肠患儿100例,随机分为两个治疗小组,试验组以及基础组,每组各50例,均给予改良Soave术治疗。基础组给予常规护理,试验组患儿给予护理干预。进行治疗。比较两个治疗小组在经过不同护理后患儿的治疗效果。结果:在两组患儿手术指标组间及组内比较方面,两组患儿的手术指标比较分析结果显示,实验组术中出血情况、手术花费时间、胃肠功能恢复和住院花费时间均显著优于基础组(P<0.05);在两组患儿术后肛门功能与并发症发生情况比较方面,两组患儿经手术后肝门功能优良率试验组要显著高于基础组,并发症的发生情况要显著低于基础组,均具有统计学意义(P<0.05)。讨论:针对先天性巨结肠术后肛门吻合口感染及肛周皮炎患者实施护理干预能够改善患者的手术指标,对于提高术后肝门功能和降低并发症发生情况有较好的效果,值得推广。

伸缩式无菌冲洗架在膝关节镜手术中的应用

目的观察膝关节镜手术中应用伸缩式无菌冲洗架的临床效果。方法招募2022年1月至2022年7月于南宁市第一人民医院骨科行膝关节镜手术的患者120例,采用随机数字表法将其分为观察组和对照组,每组60例。观察组在膝关节镜手术中采用自行设计的伸缩式无菌冲洗架配合3L医用无菌防护套,对照组在膝关节镜手术中采用常规的引流袋和引流管配合3L医用无菌防护套。比较两组患者膝关节镜手术无菌区域大小、术中手术无菌区域及手术医师手术衣溅湿情况、术后器械护士清理耗时、手术医师及护士满意度以及术口感染情况。结果观察组膝关节镜手术无菌区域面积大于对照组,术中手术无菌区域及手术医师手术衣被冲洗液溅湿发生率低于对照组,术后器械护士清理耗时短于对照组,术口感染发生率低于对照组,差异有统计学意义(P<0.05)。观察组手术医师及护士对术中使用辅助用具的便利性、实用性、省力性、术后整理等方面的满意度显著优于对照组(P<0.05)。结论在膝关节镜手术中采用伸缩式无菌冲洗架配合3L医用无菌防护套可根据手术进程扩大或缩小无菌区域操作空间,降低术口感染风险,获得了手术医师及护士的认可,值得临床推广。

基于知信行理论的护理在膀胱癌患者术后造口感染预防中的应用效果

探索分析基于知信行理论的护理在膀胱癌患者术后造口感染预防中的临床应用效果。方法 选取本院2021年1月至2023年1月治疗的100例膀胱癌患者,均实施手术疗法,经随机数表法划分为对照组(常规护理,n=50例)、观察组(基于知信行理论的护理,n=50例),探究对照两组临床应用效果。结果 观察组术后白细胞计数(WBC)低于对照组(P<0.05);观察组术后红细胞计数(RBC)、血小板计数(PLT)、血红蛋白(Hb)、并发症发生率、住院时造口感染发生率均低于对照组(P<0.05)。结论 基于知信行理论的护理能有效预防、降低膀胱癌患者术后造口感染发生,改善各项血液指标,降低术后并发症发生率,值得推荐。

藻酸盐敷料换药在肛周脓肿术后患者中的应用效果

目的:观察藻酸盐敷料换药在肛周脓肿术后患者中的应用效果。方法:选取80例肛周脓肿患者作为研究对象,依据随机数字表法将其分为对照组和研究组各40例。对照组采用凡士林纱布换药,研究组采用藻酸盐敷料换药,比较两组术口愈合时间、感染发生率和疼痛[视觉模拟评分法(VAS)]评分。结果:换药后,研究组术口愈合时间短于对照组,术口VAS评分低于对照组,差异有统计学意义(P<0.05);研究组术口感染发生率为5.00%(2/40),低于对照组的25.00%(10/40),差异有统计学意义(P<0.05)。结论:藻酸盐敷料换药应用于肛周脓肿术后患者可缩短术口愈合时间,降低VAS评分和感染发生率,效果优于凡士林纱布换药。

WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

Role of locking plates in treatment of difficult ununited fractures： a clinical study

Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Surgical treatment of infected arterial injuries of the major limb

To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department. Methods： After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient＇s condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases. Results ： 1 case （ 4.8 % ） died during the treatment. 5 cases （ 5/21, 23.8 % ） underwent amputations. Blood supply reconstruction was successful in 15 cases （15/21, 71.4%）. 93.3% （14/15） of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case （ 1/15, 6.7 % ） and a sound result was obtained after a second operation. Conclusions： Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.

Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures

Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal procedure remains unclear.In this study,we compared the effect of two surgical techniques for wound closure following ileostomy reversal:gunsight suture(GS)and linear suture(LS).Methods:A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study.These patients were divided into two groups:the LS group and the GS group.We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI.Results:Both groups successfully underwent surgery.The rate of SSI was significantly lower in the GS group(n=2,0.02%)than in the LS group(n=16,12.00%,P=0.007).The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group(8.163.2 vs 10.865.4 days,P<0.001).Multivariate analysis showed that GS was an independent protective risk factor for SSI(odds ratio=0.212,P=0.048).Conclusions:Compared with the LS technique,the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery.The GS technique may be recommended for wound closure following ileostomy reversal.