暂时性腹腔关闭联合腹腔双套管负压引流术在腹腔严重感染治疗中的应用
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摘要
目的探讨暂时性腹腔关闭(TAC)联合腹腔双套管持续负压引流技术在腹腔严重感染治疗中的应用效果。方法回顾性分析2012年7月至2017年9月解放军联勤保障部队第九○八医院收治的31例腹腔严重感染患者的临床资料,其中17例应用TAC联合腹腔双套管持续负压引流技术进行治疗(联合治疗组),14例采用传统引流方法及直接关闭腹腔进行治疗(常规治疗组),分析2组的治疗方法和效果。结果联合治疗组中14例患者腹腔感染得到有效控制,2例患者术后分别出现肠瘘、肠间隙脓肿等并发症,1例患者术后继发多器官功能衰竭而死亡。常规治疗组中有8例患者术后出现腹部并发症,2例死亡。联合治疗组较常规治疗组在术后腹部并发症发生率(17.6%vs 57.1%)、体温[(37.6±0.5)℃vs (38.1±0.5)℃]、心率[(88.7±10.7)次/min vs (99.3±13.4)次/min)]、腹内压[(17.2±4.0)mmHg vs (25.1±4.0)mmHg]、APACHEⅡ评分[(15.6±4.9)分vs(19.8±5.2)分)]、ICU住院时间[(7.6±2.2)d vs (11.0±1.9)d)]、总住院时间[(23.9±10.3)d vs (36.7±15.8)d)]等方面均显著降低(P<0.05)。结论 TAC联合腹腔双套管持续负压引流技术在严重腹腔感染的治疗中疗效显著,引流效果好,可显著降低腹内压及腹部并发症发生率,值得临床推广应用。
Objective To observe the clinical effect of temporary abdominal closure(TAC)combined with double-lumen canula negative pressure drainage utilized in the severe abdominal infection.Methods A retrospective analysis was made on the clinical data of 31 cases of severe abdominal infection treated from July 2012 to September 2017 and studied the methods and effects of treatment. Among them,17 patients were recruited in the combined treatment group and treated with TAC combined with double-lumen canula negative pressure drainage,and the other 14 patients were recruited in the conventional treatment group and treated with traditional drainage and direct closure of abdominal cavity.ResultsIn the combined treatment group,14 cases of abdominal infection were effectively controlled,2 cases were combined with complications such as postoperative intestinal fistula and interloop abscess,1 case died with postoperative multiple organ failure. In the conventional treatment group,8 patients had abdominal complications and 2 patients died. The incidence of abdominal complications(17.6%vs 57.1%),mean body temperature[(37.6±0.5)℃ vs 38.1±0.5)℃],mean heart rate[(88.7±10.7)/min vs(99.3±13.4)/min],intra-abdominal pressure[(17.2±4.0)mmHg vs(25.1±4.0)mmHg],APACHE Ⅱ score [(15.6±4.9) vs(19.8±5.2)],hospitalization time in ICU[(7.6±2.2)d vs(11.0±1.9)d)]and total hospitalization time[(23.9±10.3)d vs(36.7±15.8)d)]in the combined treatment group were significantly lower than those in the conventional treatment group(P<0.05).Conclusion TAC combined with double-lumen canula negative pressure drainage can yield remarkable therapeutic effect in severe abdominal infection and significantly decrease intra-abdominal pressure and incidence rates of abdominal complications. It is worthy of clinical promotion.
Objective To observe the clinical effect of temporary abdominal closure(TAC)combined with double-lumen canula negative pressure drainage utilized in the severe abdominal infection.Methods A retrospective analysis was made on the clinical data of 31 cases of severe abdominal infection treated from July 2012 to September 2017 and studied the methods and effects of treatment. Among them,17 patients were recruited in the combined treatment group and treated with TAC combined with double-lumen canula negative pressure drainage,and the other 14 patients were recruited in the conventional treatment group and treated with traditional drainage and direct closure of abdominal cavity.ResultsIn the combined treatment group,14 cases of abdominal infection were effectively controlled,2 cases were combined with complications such as postoperative intestinal fistula and interloop abscess,1 case died with postoperative multiple organ failure. In the conventional treatment group,8 patients had abdominal complications and 2 patients died. The incidence of abdominal complications(17.6%vs 57.1%),mean body temperature[(37.6±0.5)℃ vs 38.1±0.5)℃],mean heart rate[(88.7±10.7)/min vs(99.3±13.4)/min],intra-abdominal pressure[(17.2±4.0)mmHg vs(25.1±4.0)mmHg],APACHE Ⅱ score [(15.6±4.9) vs(19.8±5.2)],hospitalization time in ICU[(7.6±2.2)d vs(11.0±1.9)d)]and total hospitalization time[(23.9±10.3)d vs(36.7±15.8)d)]in the combined treatment group were significantly lower than those in the conventional treatment group(P<0.05).Conclusion TAC combined with double-lumen canula negative pressure drainage can yield remarkable therapeutic effect in severe abdominal infection and significantly decrease intra-abdominal pressure and incidence rates of abdominal complications. It is worthy of clinical promotion.
引文
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[11]王彦峰.负压封闭引流在腹部外科的应用[J].创伤外科杂志,2016,18(8):452-454.
[12] Regner JL,Kobayashi L,Coimbra R.Surgical strategies for management of the open abdomen[J].World J Surg,2012,36(3):497-510.
[13]任建安.腹腔开放创面的早期保护[J].医学研究生学报,2018,31(7):688-691.
[14] Szmyt K,?ukasz K,Bobkiewicz A,et al.Comparison of the effectiveness of the treatment using standard methods and negative pressure wound therapy(NPWT)in patients treated with open abdomen technique[J].Pol Przegl Chir,2015,87(1):22-30.
[15]保红平,姚永良,高瑞岗,等.持续腹腔双套管冲洗引流治疗肠外瘘[J].中华消化外科杂志,2010,9(2):96.
[16] Hlebowicz J,Hansson J,Lindstedt S.Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen[J].Int J Colorectal Dis,2012,27(3):397-403.
[17] Patel NY,Cogbill TH,Kalies KJ,et al.Temporary abdominal closure:long-term outcomes[J].J Trauma,2011,70(4):769-774.
[18]钱洪军,陈帆,朱宏亮,等.暂性时腹腔关闭技术在严重腹腔感染中的应用[J].南昌大学学报(医学版),2014,54(5):54-56.
[2]李宏亮,朱曦.腹腔内高压与腹腔间隔室综合症[J].中国微创外科杂志,2006,6(7):550-553.
[3]谷欣,桑云华,龙宏杰.腹内压变化率对评估腹腔内高压症患者病情及预后的价值[J].东南国防医药,2014,16(3):246-248.
[4]黄强,杨洋,魏安卿,等.损伤控制理论对野战卫勤保障的影响[J].东南国防医药,2013,15(5):488-490.
[5] Cho J,Benjamin E,Inaba K,et al.Severe Bleeding in Pelvic Fractures:Considerations in Planning Damage Control[J].Am Surg,2018,84(2):267-272.
[6] De Waele JJ,Leppaniemi AK. Temporary abdominal closure.Techniques[J].Am Surg,2011,77(S1):S46-S50.
[7]樊俊斌,蔺岗,刘文学,等.负压封闭引流敷料在腹腔间隔室综合征腹壁缺损中的应用[J].中国药物与临床,2017,17(6):884-886.
[8]陈帆,朱宏亮,钱洪军,等.暂时性腹腔关闭与常规关腹技术治疗严重腹腔感染的临床对比[J].中国微创外科杂志,2015,15(6):30-34.
[9]易伟,钱洪军,陈帆.十二指肠损伤的简化手术方式探讨[J].南昌大学学报(医学版),2013,53(4):41-43.
[10]王革非,任建安,王新波,等.严重腹腔感染的肠瘘病人能量代谢的连续性变化规律[J].肠外与肠内营养,2006,13(1):25-28.
[11]王彦峰.负压封闭引流在腹部外科的应用[J].创伤外科杂志,2016,18(8):452-454.
[12] Regner JL,Kobayashi L,Coimbra R.Surgical strategies for management of the open abdomen[J].World J Surg,2012,36(3):497-510.
[13]任建安.腹腔开放创面的早期保护[J].医学研究生学报,2018,31(7):688-691.
[14] Szmyt K,?ukasz K,Bobkiewicz A,et al.Comparison of the effectiveness of the treatment using standard methods and negative pressure wound therapy(NPWT)in patients treated with open abdomen technique[J].Pol Przegl Chir,2015,87(1):22-30.
[15]保红平,姚永良,高瑞岗,等.持续腹腔双套管冲洗引流治疗肠外瘘[J].中华消化外科杂志,2010,9(2):96.
[16] Hlebowicz J,Hansson J,Lindstedt S.Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen[J].Int J Colorectal Dis,2012,27(3):397-403.
[17] Patel NY,Cogbill TH,Kalies KJ,et al.Temporary abdominal closure:long-term outcomes[J].J Trauma,2011,70(4):769-774.
[18]钱洪军,陈帆,朱宏亮,等.暂性时腹腔关闭技术在严重腹腔感染中的应用[J].南昌大学学报(医学版),2014,54(5):54-56.