【摘要】 背景与目的手术切口感染是胸外科术后常见并发症之一,其危害与感染程度、部位等相关,轻者致局部疼痛、住院时间延长、费用增加,重者可导致严重感染,甚至感染性休克、危及生命。因此,妥善处理切口感染,有利于促进恢复、降低疾病负担、奠定进一步治疗良好基础。切口感染传统外科处理措施包括彻底引流、加强换药、使用抗生素等,存在治疗过程长、治疗效果不确切等不足。本研究对我科6例胸部手术术后发生感染患者尝试性使用负压封闭引流装置(vacuum sealing drainage,VSD)的经验进行总结,以期改进传统应对患者胸部手术术后感染的处理模式。方法对我院近一年来出现胸部手术术后切口感染或手术切口瘘的患者相关临床数据进行回顾和总结,选择了其中6例使用VSD材料治疗术后感染的患者,对其使用VSD处理的过程和最终临床结果进行总结讨论。结果本研究中所有患者在使用VSD后6 h-10 h内发热、伤口渗出症状消失。7天-10天后拔除引流装置,5例患者创面感染情况明显改善,伤口分泌物消失,手术切缘肉芽组织生长良好,二期手术关闭胸腔和皮肤。1例患者感染严重,去除VSD后分泌物仍较多,效果不明显,再次放置VSD装置,7天后去除VSD装置,患者手术切口无渗出,肉芽组织生长良好,二期手术关闭胸腔和皮肤。所有6例患者最终感染症状缓解,症状改善,手术切口愈合良好出院。2例食管癌患者中,平均手术时间427.5 min,术后平均住院天数40天,术后平均换药次数8.5次,住院期间平均总花费111,893.47元;4例慢性脓胸患者中,平均手术时间192.5 min,术后平均住院天数27.75天,术后平均换药次数5.5次,住院期间平均总花费48,237.71元。结论 VSD在处理胸外科手术术后切口感染患者中效果良好,减少了患者的痛苦和负担,保证了发生术后感染患者的生活质量。更多还原

【Abstract】 Background and objective Surgical site infection is one of the common postoperative complications of thoracic surgery, and its harm is related to infection degree and location. Light causes local pain, prolonged hospitalization and increased cost. Severe infection can lead to severe infection, even septic shock and life-threatening. Therefore, proper treatment of incision infection can help to promote recovery, reduce the burden of disease and lay a good foundation for further treatment. The traditional surgical treatment of wound infection includes thorough drainage, intensive dressing change and antibiotic use. There are many shortcomings such as long treatment process, ineffective treatment effect and so on. The experience of using vacuum sealing drainage(VSD) in 6 cases of postoperative infection patients in our department is summarized in order to improve the traditional treatment of postoperative infection in patients after thoracic surgery. Methods The clinical data of patients with postoperative incision infection or fistula after thoracic surgery in our department were reviewed and summarized. 6 patients treated with VSD material for postoperative infection. The process and final clinical results of them were summarized and discussed. Results In this study, fever and wound exudation disappeared within 6 h-10 h after VSD use, 5 cases of wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well at the cutting edge of the operation, the second stage operation was performed to close the chest and skin. One patient was seriously infected, and thesecretion was still more after VSD removal, reposition VSD device next time, the VSD device was removed 7 d later. The wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well, close the chest and skin second stage. In all 6 patients, the symptoms were relieved, the symptoms improved and the surgical incision healed well. In 2 patients with esophageal cancer, the average operation time was 427.5 min, the average hospitalization time was 40 d, the average number of times of dressing change was 8.5, the average total cost during hospitalization was 111,893.47 yuan patients with chronic empyema, the average operation time was 192.5 min. The average hospital stay was 27.75 days, the average number of times of dressing change was 5.5, and the average total expenditure during hospitalization was 48,237.71 yuan. Conclusion VSD has a good effect on the treatment of postoperative incision infection patients in thoracic surgery. It can reduce the pain and burden of patients and ensure the quality of life of postoperative infected patients.更多还原