目的观察持续冲洗负压引流技术在腹部外科应用的临床效果。方法回顾性分析2006年1月至2011年3月期间我院将自制双套管实施持续冲洗负压引流技术应用于172例腹部外科患者的临床资料。结果全部患者的消化道瘘均治愈，瘘道愈合的平均时间为36 d。治疗过程中，1例患者出现上消化道出血，另1例出现腹腔出血，无腹腔感染、皮肤破溃感染、脓毒症等并发症。结论采用持续冲洗负压引流的双套管制作简单，经济有效，在腹部外科中对术后肠瘘、出血、胆汁漏及感染的防治具有重要临床意义。
Ｔｏ ｆｉｎｄ ｏｕｔ ｔｈｅ ａｐｐｒｏｐｒｉａｔｅ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｆｏｒ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ａｎｄ ａｐｐｌｙ ｉｔ ｔｏ ｔｈｅ ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ｏｆ ｐａｔｉｅｎｔ ｗｉｔｈ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ ａｒｅ ｒｅｐｏｒｔｅｄ．Ａｂｄｏｍｉｎａｌ ｔｕｂｅ ｗａｓ ｉｎｓｅｒｔｅｄ ｔｏ ｒａｂｂｉｔ ｆｏｒ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｍｏｎｉｔｏｒｉｎｇ ａｎｄ ａｎｏｔｈｅｒ ｔｕｂｅ ｗａｓ ｃｕｓｅｒｔｅｄ ｉｎｔｏ ｔｈｅ ａｂｄｏｍｅｎ ｆｏｒ ｃｏｎｔｉｎｕｏｕｓ ｎｏｒｍａｌ ｓａｌｉｎｅ ｉｎｓｔｉｌｌａｔｉｏｎ．Ｔｈｅ ｒｅｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｄｒａｉｎａｇｅ ｆｌｕｉｄ ｕｎｄｅｒ ｄｉｆｆｅｒｅｎｔ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｗｅｒｅ ｍｅａｓｕｒｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｆｌｕｉｄ ｄｅｐｌｅｔｉｏｎ ｒａｔｅ（７０％）ｏｆ ｔｈｅ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｇｒｏｕｐ（１．５ ｋＰａ）ｗａｓ ｈｉｇｅｈｅｒ ｔｈａｎ ｔｈａｔ ｏｔｈｅｒ ｉｎ ３ ｇｒｏｕｐｓ（ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ０ ｋＰａ，５ ｋＰａ ａｎｄ １５ ｋＰａ）（Ｐ＜０．０１）．Ｗｉｔｈ ｔｈｉｓ ｃｏｎｔｉｎｕｏｕｓ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｉｎ ２０ ｐａｔｉｅｎｔｓ ａｆｔｅｒ ｓｅｖｅｒｅ ｐａｎｃｒｅａｔｉｔｉｓ ｏｐｅｒａｔｉｏｎ，ｗｅ ｆｏｕｎｄ ｔｈａｔ ｔｈｉｓ ｍｅｔｈｏｄ ｈａｖｅ ｍｏｒｅ ａｄｖａｎｔａｇｅｓ ｏｆ ｒｅｄｕｃｉｎｇ ｃｏｍｐｌｉｃａｔｉｏｎ，ｐｒｏｍｏｔｉｎｇ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｄｕｃｉｎｇ ｄｅａｔｈ ｒａｔｅ．
Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.
【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.