负压封闭引流技术在胸外科手术后胸壁切口感染治疗中的临床应用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 李明霞 , 杨梅 , 李霞 , 徐志华

四川大学华西医院胸外科，成都 610041;

Corresponding author：

李明霞, Email: a466961729@163.com

Keywords：

伤口感染; 负压封闭引流; 胸外科

DOI：

10.7507/1007-4848.20140116

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目的总结使用负压封闭引流技术治疗胸壁伤口感染的初步经验及体会。方法回顾性分析2011年7月至2013年10月四川大学华西医院16例开胸手术后发生胸壁切口感染患者的临床资料，其中男13例，女3例；年龄（50.8±6.7）岁。手术种类包括脓胸廓清术、肺叶切除术、纵隔肿瘤切除术和食管癌根治术。通过应用负压封闭引流技术，进行伤口的持续负压吸引治疗，观察治疗效果，积累初步经验。结果经过持续负压引流，16例患者中有3例未达到二期缝合的标准（负压封闭引流愈合标准），其中2例由于患者耐受差，不愿继续使用，转为每日更换敷料；1例由于伤口感染控制不佳，感染范围增加，更换为每日换药治疗。总的负压封闭引流治疗愈合率为81.2%（13/16）。6例（37.5%）患者为多次安置负压封闭引流。累计保留负压封闭引流时间为4～24 d，中位时间9 d。治疗过程中无负压封闭引流相关不良事件发生。随访11例，随访时间2～8个月，失访5例。11例患者中，1例出现轻微的伤口异物反应（皮下缝线），经拆除皮下缝线后治愈；其余患者伤口均愈合良好，未见感染复发。结论负压封闭引流技术治疗胸外科手术后胸壁切口感染安全、可行、有效，患者耐受好，具有较高的临床应用价值。而通过初期的使用经验总结，有利于我们拓展负压封闭引流技术的应用领域，整体提高胸外科手术后伤口感染的治疗效果。

Citation： 李明霞, 杨梅, 李霞, 徐志华. 负压封闭引流技术在胸外科手术后胸壁切口感染治疗中的临床应用. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 421-423. doi: 10.7507/1007-4848.20140116 Copy

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7.	Tang AT, Okri SK, Haw MP. Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery. J Wound Care, 2000, 9 (5):229-230.
8.	王显悦, 王晓武, 毕生辉, 等.封闭负压引流技术在心脏手术后切口感染治疗中的应用.中国胸心血管外科临床杂志, 2012, 19 (5):529-533.
9.	安君, 王巍, 樊纪丹, 等.心脏大血管手术后胸骨感染的外科治疗.中国胸心血管外科临床杂志, 2011, 18 (5):476-477.
10.	Hersh RE, Jack JM, Dahman MI, et al. The vacuum-assisted closure device as a bridge to sternal wound closure. Ann Plast Surg, 2001, 46 (3):250-254.
11.	Fleck TM, Fleck M, Moidl R, et al. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg, 2002, 74 (5):1596-1600.
12.	Harlan JW. Treatment of open sternal wounds with the vacuum-assisted closure system:a safe, reliable method. Plast Reconstr Surg, 2002, 109 (2):710-712.
13.	Ramnarine IR, Mclean A, Pollock JC. Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis. Eur J Cardiothorac Surg, 2002, 22 (6):1029-1031.
14.	钱冬兰, 张伟, 邵燕.简易负压封闭吸引治疗开胸术后难愈切口患者的护理.中国肿瘤外科杂志, 2013, 5 (3):202-203.
15.	詹锋, 姜镭, 裘华德.负压封闭引流术治疗胸壁结核临床研究.中华实验外科杂志, 2011, 28 (3):461-461.

1. Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg, 1993, 96 (9):488-492.
2. 杨帆, 白祥军.创面治疗的新理念——负压封闭引流技术.中华外科杂志, 2010, 48 (5):387-389.
3. Argenta LC, Morykwas MJ. Vacuum-assisted closure:a new method for wound control and treatment:clinical experience. Ann Plast Surg, 1997, 38 (6):563-577.
4. Ferron G, Garrido I, Martel P, et al. Combined laparoscopically harvested omental flap with meshed skin grafts and vacuum-assisted closure for Reconstruction of complex chest wall defects. Ann Plast Surg, 2007, 58 (2):150-155.
5. Bludau M, Hölscher AH, Herbold T, et al. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc, 2014, 28 (3):896-901.
6. Obdeijn MC, de Lange MY, Lichtendahl DH, et al. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. Ann Thorac Surg, 1999, 68 (6):2358-2360.
7. Tang AT, Okri SK, Haw MP. Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery. J Wound Care, 2000, 9 (5):229-230.
8. 王显悦, 王晓武, 毕生辉, 等.封闭负压引流技术在心脏手术后切口感染治疗中的应用.中国胸心血管外科临床杂志, 2012, 19 (5):529-533.
9. 安君, 王巍, 樊纪丹, 等.心脏大血管手术后胸骨感染的外科治疗.中国胸心血管外科临床杂志, 2011, 18 (5):476-477.
10. Hersh RE, Jack JM, Dahman MI, et al. The vacuum-assisted closure device as a bridge to sternal wound closure. Ann Plast Surg, 2001, 46 (3):250-254.
11. Fleck TM, Fleck M, Moidl R, et al. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg, 2002, 74 (5):1596-1600.
12. Harlan JW. Treatment of open sternal wounds with the vacuum-assisted closure system:a safe, reliable method. Plast Reconstr Surg, 2002, 109 (2):710-712.
13. Ramnarine IR, Mclean A, Pollock JC. Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis. Eur J Cardiothorac Surg, 2002, 22 (6):1029-1031.
14. 钱冬兰, 张伟, 邵燕.简易负压封闭吸引治疗开胸术后难愈切口患者的护理.中国肿瘤外科杂志, 2013, 5 (3):202-203.
15. 詹锋, 姜镭, 裘华德.负压封闭引流术治疗胸壁结核临床研究.中华实验外科杂志, 2011, 28 (3):461-461.

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负压封闭引流技术在胸外科手术后胸壁切口感染治疗中的临床应用

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