ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
目的 观察运用两种不同缝线固定修补材料对疝修补术后的复发、切口感染、慢性疼痛等并发症发生情况。方法 对2008年4月至2010年4月期间笔者所在科室收治的250例腹股沟疝患者行无张力疝修补手术时，采用多股丝线或可吸收合成缝线固定修补材料进行前瞻性对比研究。结果 2组患者术后疝复发、切口感染和切口疼痛（包括慢性疼痛）发生率间的差异均无统计学意义（P＞0.05）。结论 腹股沟疝无张力修补术后的复发、切口感染、慢性疼痛等并发症的发生与缝线选择无关。术者的操作技巧、严格的无菌操作原则、彻底止血以及组织损伤小才是防止术后感染、慢性疼痛等并发症发生的重要因素。
Abstract： Objective To introduce the early experience of using vacuum-assisted closure （VAC） in the treatment of wound dehiscence after thoracic and cardiovascular surgery. Methods This report retrospective1y analyzed the clinical data of 12 patients who underwent VAC in the treatment of wound dehiscence after thoracic and cardiovascular surgery in the Affiliated Hospital of the Logistics University of CAPF between October 2010 and October 2011. There were 7 male patients and 5 female patients with their mean age of 64.3 years （ranging from 39 to 80 years）. All patients underwent operation via median sternotomy or lateral thoracic incision. All the wound dehiscence was deep to sternum or rib. After debridement of necrotic tissue, the wound surfaces were covered with VAC sponges, and intermittent negative pressure therapy was used. The VAC sponges were changed every 7-10 days. Results All the patients underwent an average of 2 times to change the VAC sponges during VAC treatment. After VAC treatment, the edema around the surgical wounds gradually disappeared, and the granulation tissue was refreshed. The overall conditions of all the patients were improved. The patients could leave their bed, walk in the ward, and look after themselves. Antibiotic treatment was no longer used. The residents checked up the negative pressure system every day to see whether it worked well. The patients were no longer afraid of changing dressing and pain every day. All the patients were healed, discharged from the hospital and followed up at outpatient department for a mean time of 7 months. Their wounds all healed well during follow-up. Conclusion VACsystem is easy to use. It can facilitate the healing of wound dehiscence quickly, decrease the inflammatory reaction of local wound and the body, and shorten the rehabilitation time. It’s also helpful to reduce the residents’ work load. It is recommended in the treatment of wound dehiscence after thoracic and cardiovascular surgery.
摘要:目的: 探讨在阑尾切除术中应用抗菌薇乔缝线以减少阑尾切口感染的可能性。 方法 : 将我院2007年4月至2009年3月所有阑尾切除术病例1425例随机分为抗菌薇乔缝线组和丝线组,比较其切口感染发生率。 结果 : 统计中按阑尾未穿孔、阑尾穿孔以及总计分别计算切口感染率,在抗菌微乔线组感染率分别为017%、072%、028%,丝线组分别为154%、781%、267%,两组间分别予以X2检验,其〖WTBX〗P 值均小于001,具有显著性差异。 结论 : 缝线是辅助产生切口感染的一个危险因素,在阑尾切除术中使用抗菌薇乔缝线可以显著降低切口感染率。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 探讨急性化脓穿孔性阑尾炎术后切口感染的相关因素。方法 回顾性分析2009年1月至2011年6月期间我院普外科手术治疗的化脓穿孔性阑尾炎161例患者的临床资料。结果 161例患者中35例（21.7%）发生了切口感染。单因素分析结果表明，肥胖（体质指数＞30kg/m2）、手术时间超过1h、术前未预防性应用抗生素及术后首次切口换药时间＞3d者切口感染发生率高（P＜0.05）；多因素分析结果表明，手术时间超过1h及术前未预防性应用抗生素是急性化脓穿孔性阑尾炎术后切口感染的独立危险因素（P＜0.05）。结论 早期诊治、降低手术时间、术前合理预防性应用抗生素有助于减少切口感染机会。
ObjectiveTo evaluate the role of triclosan-coated polyglactin 910 suture in reducing wound infections of emergency gastrointestinal surgeries. MethodsThis was a prospective, randomized, controlled, single center study. From May 2009 to August 2010, 412 patients underwent emergency gastrointestinal operations in our department, 198 of them were chose randomly as experimental group using triclosancoated polyglactin 910 suture for abdominal wall closure， 214 using traditional braiding suture were taken as control. The risk factors for wound healing were analyzed, and wound infection rate was compared between two groups. ResultsThere were no significant differences of gender, age, body mass index, combined diabetes, use of immunosuppressant, and glucocorticoid steroid, type of incision, intraoperative bleeding volume, and operation time between two groups (Pgt;0.05). Wound infection rate of experimental group 〔3.0% (6/198）〕 was significantly lower than that of control group 〔11.7% (25/214), Plt;0.001〕. Especially in subgroup of type Ⅲ incision and operative time more than 120 min, wound infection rate was significantly different between experimental group and control group 〔3.5%(5/141) versus 14.3%(22/154); 3.3%(2/60) versus 21.2%(11/52) respectively, Plt;0.001〕. ConclusionTriclosancoated polyglactin 910 suture can reduce wound infection rate of gastrointestinal emergency operations, especially with type Ⅲ incision and operation time ≥120 min.
目的探讨阑尾切除术后腹腔引流放置与否对切口感染的影响。方法回顾性分析1 719例阑尾手术的引流情况和切口感染情况。结果引流组切口感染率为50.93%，未引流组为3.17%(Plt;0.005)。其中单纯性阑尾炎引流组感染率为33.33%，未引流组为1.66%； 化脓性阑尾炎引流组感染率为46.43%，未引流组为3.12%； 坏疽性阑尾炎引流组感染率为56.25%，未引流组为20.00%； 穿孔性阑尾炎引流组感染率为54.95%，未引流组为23.08%。结论无论何种类型阑尾炎，术后放置腹腔内引流均可能增加切口感染。
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.