小流量负压引流在腹壁排粪造口旁感染中的应用价值研究（附 18 例病例分析）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

吕其君 , 侯华芳 , 谢雪虹 ,  王崇树

川北医学院附属医院胃肠外科（四川南充 637000）;

Corresponding author：

王崇树, Email: chongshuwang@126.com

Keywords：

负压引流装置; 造口旁感染; 治疗效果

DOI：

10.7507/1007-9424.201607069

Video：

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目的研究小流量负压引流装置在严重造口旁感染处理中的可行性与应用效果。方法回顾性分析川北医学院附属医院 2013 年 5 月至 2016 年 5 月期间收治的 18 例严重肠造口旁感染患者的临床资料，根据造口旁感染发生后处理方法的不同分为一般换药处理组（简称“换药组”，n=8）和小流量负压引流组（简称“引流组”，n=10），对 2 组的临床治疗效果进行比较。结果 2 组患者的一般资料如年龄、性别、体质量指数、原发病、造口部位、合并症、感染发生的时间等比较差异无统计学意义（P>0.05）。引流组 10 例患者感染灶内脓液、积液引流效果佳，创面愈合良好，所有感染创口均愈合后患者顺利出院；随访期为 1～36 个月，其中 1 例发生造口旁疝。换药组 8 例患者中 7 例患者感染创面顺利愈合，另有 1 例因感染面积扩大伴局部肠管部分缺血坏死，自发现感染后第 5 天另行肠切除肠造口术，原切口术后经换药处理后于第 10 天愈合出院；随访期为 2～36 个月，无其他并发症发生。引流组患者的造口旁感染病灶愈合时间和总住院时间均明显短于换药组（P<0.05），2 组的并发症发生率比较差异无统计学意义（P>0.05）。结论从本研究有限的数据初步研究结果来看，小流量负压引流装置在造口旁感染中应用安全、有效，且易于掌握、取材便利。

Citation： 吕其君, 侯华芳, 谢雪虹, 王崇树. 小流量负压引流在腹壁排粪造口旁感染中的应用价值研究（附 18 例病例分析）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 498-501. doi: 10.7507/1007-9424.201607069 Copy

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6.	Pearl RK, Prasad ML, Orsay CP,et al. Early local complications from intestinal stomas. Arch Surg, 1985, 120(10): 1145-1147.
7.	Clavijo-Alvarez JA. Novel technique for skin grafting parastomal wounds using a negative-pressure dressing. Adv Skin Wound Care, 2014, 27(6): 256-258.
8.	Kaufman JL. Surgical drainage of a small tissue volume with butterfly infusion and vacuum phlebotomy tube sets. J Am Coll Surg, 2015, 220(6): e79-e80.
9.	Karadsheh MJ, Nelson J, Wilcox R. The application of skin adhesive to maintain seal in negative pressure wound therapy. Wounds, 2015, 27(9): 244-248.
10.	Timmons J, Russell F. The use of negative-pressure wound therapy to manage enteroatmospheric fistulae in two patients with large abdominal wounds. Int Wound J, 2014, 11(6): 723-729.
11.	Liu WH, Pai L, Wu CC,et al. Postoperatively parastomal infection following emergent stoma creation for colorectal obstruction: the possible risk factors. Int J Colorectal Dis, 2008, 23(9): 869-873.
12.	Kobayashi S, Ito M, Sugito M,et al. Association between incisional surgical site infection and the type of skin closure after stoma closure. Surg Today, 2011, 41(7): 941-945.
13.	Petkar KS, Dhanraj P, Kingsly PM,et al. A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns, 2011, 37(6): 925-929.
14.	Yoong S, Dunne G, Cochrane J,et al. Vacuum-assisted closure for the treatment of parastomal skin necrosis: a novel approach to an unusual complication. Report of a case. Dis Colon Rectum, 2008, 51(10): 1577-1579.
15.	Webster J, Scuffham P, Stankiewicz M,et al. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev, 2014, 7(10): CD009261.
16.	Ng CS, Wolfsen HC, Kozarek RA,et al. Chronic parastomal ulcers: spectrum of dermatoses. J ET Nurs, 1992, 19(3): 85-90.
17.	Park JJ, Del Pino A, Orsay CP,et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum, 1999, 42(12): 1575-1580.

1. Brandsma HT, Hansson BM, Aufenacker TJ,et al. Prophylactic mesh placement during formation of an end-colostomy reduces the rate of parastomal hernia: short-term results of the Dutch PREVENT-trial. Ann Surg, 2016 Jul 29. [Epub ahead of print].
2. 卫洪波, 陈登庭, 郑宗珩, 等. 直肠癌患者 Miles 术结肠造口并发症的预防和处理. 中华胃肠外科杂志, 2003, 6(3): 164-166.
3. Saghir JH, McKenzie FD, Leckie DM,et al. Factors that predict complications after construction of a stoma: a retrospective study. Eur J Surg, 2001, 167(7): 531-534.
4. 黄榕康, 何丹丹, 赵洁, 等. 直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析. 中国普外基础与临床杂志, 2016, 23(11): 1335-1338.
5. Duchesne JC, Wang YZ, Weintraub SL,et al. Stoma complications: a multivariate analysis. Am Surg, 2002, 68(11): 961-966.
6. Pearl RK, Prasad ML, Orsay CP,et al. Early local complications from intestinal stomas. Arch Surg, 1985, 120(10): 1145-1147.
7. Clavijo-Alvarez JA. Novel technique for skin grafting parastomal wounds using a negative-pressure dressing. Adv Skin Wound Care, 2014, 27(6): 256-258.
8. Kaufman JL. Surgical drainage of a small tissue volume with butterfly infusion and vacuum phlebotomy tube sets. J Am Coll Surg, 2015, 220(6): e79-e80.
9. Karadsheh MJ, Nelson J, Wilcox R. The application of skin adhesive to maintain seal in negative pressure wound therapy. Wounds, 2015, 27(9): 244-248.
10. Timmons J, Russell F. The use of negative-pressure wound therapy to manage enteroatmospheric fistulae in two patients with large abdominal wounds. Int Wound J, 2014, 11(6): 723-729.
11. Liu WH, Pai L, Wu CC,et al. Postoperatively parastomal infection following emergent stoma creation for colorectal obstruction: the possible risk factors. Int J Colorectal Dis, 2008, 23(9): 869-873.
12. Kobayashi S, Ito M, Sugito M,et al. Association between incisional surgical site infection and the type of skin closure after stoma closure. Surg Today, 2011, 41(7): 941-945.
13. Petkar KS, Dhanraj P, Kingsly PM,et al. A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns, 2011, 37(6): 925-929.
14. Yoong S, Dunne G, Cochrane J,et al. Vacuum-assisted closure for the treatment of parastomal skin necrosis: a novel approach to an unusual complication. Report of a case. Dis Colon Rectum, 2008, 51(10): 1577-1579.
15. Webster J, Scuffham P, Stankiewicz M,et al. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev, 2014, 7(10): CD009261.
16. Ng CS, Wolfsen HC, Kozarek RA,et al. Chronic parastomal ulcers: spectrum of dermatoses. J ET Nurs, 1992, 19(3): 85-90.
17. Park JJ, Del Pino A, Orsay CP,et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum, 1999, 42(12): 1575-1580.

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小流量负压引流在腹壁排粪造口旁感染中的应用价值研究（附 18 例病例分析）

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