Objective To introduce the experience about thereconstruction of median sternotomy wound dehiscence. Methods From February 2002 to October 2004, 10 patients with median sternotomy wound dehiscence due to coronary artery revascularization were treated. There were 7 males and 3 females, aging from 68 to 76 years. The sizes of defects ranged from3 cm×5 cm to 5 cm×15 cm. After debridement of necrotic soft tissue, sternum and rib, infected median sternotomy wound was reconstructed with rectus abdominis myocutanous flap, pectoralis major myocutanous flap and latissimus dorsi flap or single muscle flap. The sizes of flaps ranged from 3 cm×5 cm to 5 cm×16 cm.Results Allpatients were followed up from 3 to 11 months with anaverage of 6 months. All the patients achieved healing by first intention with normal respiration and normal function of upper limbs. The wound of donor site healed well.No abdominal hernia and other complications occurred. The wound of donor site healed well.The results were satisfactory.Conclusion According to different stages of the disease and different conditions of an operation, the surgical management should vary with each individual.
摘要:目的: 探討在闌尾切除術中應用抗菌薇喬縫線以減少闌尾切口感染的可能性。 方法 : 將我院2007年4月至2009年3月所有闌尾切除術病例1425例隨機分為抗菌薇喬縫線組和絲線組,比較其切口感染發生率。 結果 : 統計中按闌尾未穿孔、闌尾穿孔以及總計分別計算切口感染率,在抗菌微喬線組感染率分別為017%、072%、028%,絲線組分別為154%、781%、267%,兩組間分別予以X2檢驗,其〖WTBX〗P 值均小于001,具有顯著性差異。 結論 : 縫線是輔助產生切口感染的一個危險因素,在闌尾切除術中使用抗菌薇喬縫線可以顯著降低切口感染率。Abstract: Objective: To investigate the application of Coated VICRYL Plus Antibacterial suture in order to reduce the possibility of infection of appendectomy incision. Methods : Hospital from April 2007 to March 2009 appendectomy patients in all 1425 cases were randomly divided into Coated VICRYL Plus Antibacterial suture group and silk group,compared to the incidence of incision infection. Results : The statistics are not in accordance with perforated appendicitis, perforated appendicitis, as well as calculation of the total, respectively, incision infection, the infection rate in the Coated VICRYL Plus Antibacterial suture group were 017%, 072%, 028%, silk group were 154%, 781%, 267% between the two groups separately X2 test, the P value of less than 001, with a significant difference. Conclusion : The suture is to assist the incision produced a risk factor for infection in appendectomy,Coated VICRYL Plus Antibacterial suture can be used in a significant reduction in incision infection rates.
目的 分析胃腸外科手術切口感染的影響因素，為醫院感染的防治提供理論依據。 方法 回顧性分析2010年12月－2012年12月764例行胃腸外科手術患者的臨床資料，并用單因素χ2檢驗統計分析患者醫院感染的危險因素。 結果 共有65例患者發生手術切口感染，其感染率為8.5%，且分離培養出合格菌株48株，陽性率73.8%，其中G?菌32株，占66.7%，G+菌16株，占33.3%。G?菌主要以大腸桿菌、變形桿菌、克雷伯桿菌和腸桿菌為主，分別占29.2%、18.8%、12.5%和6.2%；G+菌以腸球菌和表皮葡萄球菌為主，分別占22.9%和10.4%。單因素χ2檢驗顯示年齡＞60歲、手術時間＞120 min、術中有輸血、且有腫瘤病變的患者具有較高的切口感染發生率（P＜0.05）。 結論 胃腸外科手術切口感染的主要致病菌是G?桿菌，患者的年齡、手術時間、術中輸血情況和疾病良惡性質是術后切口感染的高危因素，積極采取相應的預防措施有望減低其感染的發生率。
ObjectiveTo explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.MethodsThe clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.ResultsThe average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).ConclusionPedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.
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。
Objective To investigate factors for surgical difficulty and complications following closure of temporary ileostomy for rectal cancer. Methods The clinical data of 103 patients with low rectal cancer treated with closure of temporary ileostomy from January 2014 to July 2017 in the Northern Theater Command General Hospital were retrospectively analyzed. The associated factors of surgical difficulty and postoperative complications were identified by the univariate and multivariate logistic regression analyses. Results In this study, there were 11 (10.7%) patients with surgical difficulty (operation time >100 min) in the 103 patients. The multivariate logistic regression analysis showed that the history of previous abdominal surgery ［OR=5.272, 95% CI (1.325, 20.977), P=0.018］ and minimally invasive surgery ［OR=0.166, 95% CI (0.037, 0.758), P=0.020］ were the independent influencing factors of the difficulty of surgery. The complications following closure of temporary ileostomy included 16 (15.5%) patients with the incision infection, 5 (4.9%) patients with the intestinal obstruction, and 3 patients with the pulmonary infection (2.9%). The multivariate logistic regression analysis showed that the diabetes ［OR=4.855, 95% CI (1.133, 20.804), P=0.033］, operation time >100 min ［OR=11.914, 95% CI (2.247, 63.171), P=0.004］, and peristomal dermatitis ［OR=18.814, 95% CI (3.978, 88.988), P<0.001］ were the independent influencing factors for the incision infection. Conclusions History of previous abdominal surgery is main cause for difficulty of surgery and minimally invasive surgery can reduce difficulty of surgery. Diabetes mellitus, longer operation time, and peristomal dermatitis are main causes of postoperative incision infection.
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。