目的 探討急性化膿穿孔性闌尾炎術后切口感染的相關因素。方法 回顧性分析2009年1月至2011年6月期間我院普外科手術治療的化膿穿孔性闌尾炎161例患者的臨床資料。結果 161例患者中35例（21.7%）發生了切口感染。單因素分析結果表明，肥胖（體質指數＞30kg/m2）、手術時間超過1h、術前未預防性應用抗生素及術后首次切口換藥時間＞3d者切口感染發生率高（P＜0.05）；多因素分析結果表明，手術時間超過1h及術前未預防性應用抗生素是急性化膿穿孔性闌尾炎術后切口感染的獨立危險因素（P＜0.05）。結論 早期診治、降低手術時間、術前合理預防性應用抗生素有助于減少切口感染機會。
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
目的 探討急性闌尾炎手術后切口感染的相關因素。方法 觀察我院2002年5月至2007年5月期間收治的665例急性闌尾炎患者采用術前預防使用抗生素、術中保護切口、術后加強切口管理等處理后切口感染情況，并分析切口感染與闌尾炎的病程、手術時間、切口選擇、留置引流和病理類型之間的關系。結果 本組患者中32例發生切口感染，感染率為4.81% (32/665)，急性闌尾炎術后切口感染與性別無關（ P ＞ 0.05），與病程長短、切口選擇、手術時間、腹腔留置引流與否以及病理類型均有關（ P ＜ 0.01）。結論 病程長、手術時間久、炎癥較重的急性闌尾炎病例切口感染率較高； 做好圍手術期的處理，術中盡量保護切口可以降低切口感染率。
目的 觀察運用兩種不同縫線固定修補材料對疝修補術后的復發、切口感染、慢性疼痛等并發癥發生情況。方法 對2008年4月至2010年4月期間筆者所在科室收治的250例腹股溝疝患者行無張力疝修補手術時，采用多股絲線或可吸收合成縫線固定修補材料進行前瞻性對比研究。結果 2組患者術后疝復發、切口感染和切口疼痛（包括慢性疼痛）發生率間的差異均無統計學意義（P＞0.05）。結論 腹股溝疝無張力修補術后的復發、切口感染、慢性疼痛等并發癥的發生與縫線選擇無關。術者的操作技巧、嚴格的無菌操作原則、徹底止血以及組織損傷小才是防止術后感染、慢性疼痛等并發癥發生的重要因素。
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.
目的 觀察可調節負壓引流技術聯合局部氧療治療腹部切口感染創面的臨床效果。 方法 對2009年5月－2012年9月28例腹部切口感染創面患者使用可調節負壓引流技術聯合局部氧療治療，創口內填入負壓吸附墊，持續輸氧0.5～1 L/min，可調節負壓采用連續工作模式，使密閉創面保持60～120 mm Hg（1 mm Hg=0.133 kPa）的負壓狀態，3～7 d更換負壓吸附墊和引流管。 結果 28例切口創面感染得到控制。8例經一次治療創面愈合，15例經2～4次治療創面愈合，2例行Ⅱ期縫合，3例患者對貼膜過敏，治療一次后改為換藥治療。28例患者創面愈合時間4～28 d，平均14 d，隨訪1～18個月無切口裂開，7例有凹陷瘢痕，余瘢痕平整。 結論 可調節負壓引流技術聯合局部氧療治療腹部切口感染創面，具有操作簡便、安全可靠、療效明顯的優點，可加快創面愈合，縮短住院時間，提高切口的愈合質量，減輕患者痛苦及醫務人員的工作量。
ObjectiveTo evaluate the role of triclosan-coated polyglactin 910 suture in reducing wound infections of emergency gastrointestinal surgeries. MethodsThis was a prospective, randomized, controlled, single center study. From May 2009 to August 2010, 412 patients underwent emergency gastrointestinal operations in our department, 198 of them were chose randomly as experimental group using triclosancoated polyglactin 910 suture for abdominal wall closure， 214 using traditional braiding suture were taken as control. The risk factors for wound healing were analyzed, and wound infection rate was compared between two groups. ResultsThere were no significant differences of gender, age, body mass index, combined diabetes, use of immunosuppressant, and glucocorticoid steroid, type of incision, intraoperative bleeding volume, and operation time between two groups (Pgt;0.05). Wound infection rate of experimental group 〔3.0% (6/198）〕 was significantly lower than that of control group 〔11.7% (25/214), Plt;0.001〕. Especially in subgroup of type Ⅲ incision and operative time more than 120 min, wound infection rate was significantly different between experimental group and control group 〔3.5%(5/141) versus 14.3%(22/154); 3.3%(2/60) versus 21.2%(11/52) respectively, Plt;0.001〕. ConclusionTriclosancoated polyglactin 910 suture can reduce wound infection rate of gastrointestinal emergency operations, especially with type Ⅲ incision and operation time ≥120 min.
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.