中国实用外科杂志

中国实用外科杂志

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应用皮下负压引流器预防下消化道开放手术切口愈合不良回顾性队列研究

李    俊a，王    今a，武珊珊b，谢付骁a，徐    威a，张大庆a，张伟涛a，杨    鋆a，庞    凯a，尹    杰a，吴国聪a，杨盈赤a，金    岚a，张    军a，姚宏伟a，张忠涛a   

  1. 首都医科大学附属北京友谊医院 a.普外科 结直肠肿瘤临床诊疗与研究中心  国家消化系统疾病临床研究中心普外分中心  b.临床流行病学与循证医学室 国家消化系统疾病临床医学研究中心方法学平台，北京100050
  • 发布日期:2020-07-23

  • Published:2020-07-23

摘要： 目的    探讨应用皮下负压引流器预防下消化道开腹手术切口愈合不良的价值。方法    回顾性分析2018年10月至2020年1月首都医科大学附属北京友谊医院普外科收治的113例下消化道开放手术病人的临床资料。根据腹壁缝合时是否放置皮下引流器，分为皮下引流组（78例）和对照组（35例）。比较两组病人切口愈合情况，分析切口愈合不良与临床特征的关系以及开放手术切口愈合不良的影响因素。结果    113例病人中，切口愈合不良发生率为14.2%（16/113），其中皮下引流组切口愈合不良发生率为5.1%（4/78），对照组为34.3%（12/35），两组差异具有统计学意义（P<0.05）。多因素分析提示，影响切口愈合不良发生的独立危险因素为未放置皮下引流器（OR=14.510，95%CI 3.411~61.735，P=0.001）、糖尿病（OR=7.064，95%CI 1.286~38.789，P=0.024）及吻合口漏/残端漏（OR=15.004，95%CI 1.876~119.996，P=0.011）。结论  下消化道开放手术切口愈合不良发生率较高，应用皮下负压引流器能有效减少其发生，且操作方便、价格低廉。

关键词: 皮下负压引流器, 下消化道, 开放手术, 切口愈合, 手术部位感染

Abstract: Subcutaneous closed-suction drainage affects surgical wound healing in lower gastrointestinal open surgery: A retrospective cohort study        LI Jun*，WANG Jin，WU Shan-shan，et al. *Department of General Surgery，Beijing Friendship Hospital，Capital Medical University；National Clinical Research Center for Digestive Disease；Clinical Center for Colorectal Cancer，Capital Medical University，Beijing 100050，China
Corresponding authors：YAO Hong-wei，E-mail：yaohongwei@ccmu.edu.cn；ZHANG Zhong-tao，E-mail：zhangzht@ccmu.edu.cn
LI Jun and WANG Jin are the first authors who contributed equally to the article
Abstract    Objective    To evaluate whether subcutaneous closed-suction drainage would increase the incidence of poor surgical site healing in lower gastrointestinal open surgery. Methods    The clinical data of 113 patients who had undergone lower gastrointestinal open surgery from October 2018 to January 2020 in a single surgeon group，Beijing Friendship Hospital，Capital Medical University were analyzed retrospectively. In the experimental group（78 case），the closed-suction drainage device subcutaneous was placed，while in the control group（35 cases），the closed-suction drainage device was not placed when the abdominal wall was sutured. The differences of surgical wounds healing and clinical manifestations，the relationship between the incidence of poor surgical wounds healing and clinical manifestations and the independent risk factors of the incidence of poor surgical wounds healing in lower gastrointestinal open surgery were analyzed. Results    In 113 patients, the incidence of poor surgical wounds healing (Grade B and C) was 14.2% (16/113)，while in subcutaneous closed-suction drainage group was 5.1% (4/78) and that in the control group was 34.3% (12/35). The difference between the two groups was statistically significant (P<0.05). The results of logistic regression analysis was that the independent risk factors of poor surgical wounds healing were no subcutaneous closed-suction drainage（OR=14.510，95%CI 3.411-61.735，P=0.001），diabetes mellitus （OR=7.064，95%CI 1.286-38.789，P=0.024） and anastomotic leakage or stump leakage （OR=15.004，95%CI 1.876-119.996，P=0.011）. Conclusion    The subcutaneous closed-suction drainage device is easy to use，cheap and beneficial for preventing poor surgical wounds healing in lower gastrointestinal open surgery.

Key words: subcutaneous closed-suction drainage, lower gastrointestinal surgery, open surgery, surgical wounds healing, surgical site infection