烧伤外科深度创面修复手术的疗效分析  

Clinical Analysis on the Surgery of Deep Wound Repair in Burns Surgical Patients

作　　者：倪俊[1] 许献荣[1] 顾海峰[1] 陈瑞彩[1] 张杏梅[1] 

机构地区：[1]中国人民解放军第85医院烧伤整形外科,上海200052

出　　处：《中国现代手术学杂志》2014年第4期280-284,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结烧伤外科深度创面修复手术的临床经验。方法对2006年1月-2013年12月间我科行深度创面修复手术的210例患者（共312处创面）临床资料进行分析。按创面病损因素分为热力烧伤组142处创面、特殊烧伤组（包括电烧伤、化学烧伤、热压伤）94处创面和非烧伤组（包括外伤、手术后创面及各种非烧伤的慢性难愈性创面）76处创面。根据手术时间分为早期手术组36处和非早期手术组276处，根据手术方式分为一期修复组263处和延期修复组49处，根据不同创面分为非难愈性创面组129处和难愈性创面组183处。比较各组间再手术率和创面愈合效果的差异。结果本组64处创面行缝合术，300处行皮片移植术，42处采用各种皮瓣修复，31处行异种皮覆盖术、负压持续吸引及清创术。其中125处创面手术为再手术，包括71处创面计划再手术和54处创面非计划再手术。特殊烧伤组非计划再手术率明显低于热力烧伤组和非烧伤组（P〈0．01），难愈性创面组的计划再手术率和非计划再手术率均明显高于非难愈性创面组（P〈0．01）。除5处缝合伤口经再手术7次愈合，余缝合伤口均正常愈合。皮片愈合优、良、差者分别为191、66和43处。皮瓣愈合优、良、差者分别为33、5和4处。早期手术组皮片愈合效果明显优于非早期手术组（P〈0．05），延期修复组皮片愈合明显优于一期修复组（P〈0．05），非难愈性创面组皮片愈合效果明显优于难愈性创面组（P〈0．01）。组间皮瓣愈合效果比较均无统计学差异（P〉0．05）。按病因分组后，仅热力烧伤患者非难愈性创面组皮片愈合明显优于难愈性创面组（P〈0．01）。结论合理选择皮片或皮瓣修复深度创面是取得治疗成功的重要环节，早期皮片手术、延期皮片手术和非难愈性创面皮片手术的疗效较好。积极开展非早期手术和一期修Objective To summarize the experience on the surgery of deep wound repair in burns surgical patients. Methods The clinical data of 210 patients with deep wound performed repair operation from January 2006 to December 2013 were enrolled and summarized retrospectively. The wounds caused by three types ： thermal burn in 142 wounds, special burn （ included electricity bums, chemicals bums and hot crush injury） in 94 wounds and non-bums （ included post-trauma wound, post-operation wound and non-bum chronic refractory wound） in 76 wounds. The patients were divided into early operation group and non-early operation group with 36 and 276 wounds for each according of different time of operation, while into primary repair group and delay repair group with 263 and 49 wounds for each according of different operation methods. According to the different wound, the patients were divided into non-refractory wound group and refractory wound group with 129 and 183 wounds for each. Therapeutic methods, reoperation rate and wound healing conditions of all patients were statistically analyzed. Results There were 312 wounds in various parts of the body in all 210 cases. Under the premise of relatively stable systemic and wound condition of the patients, certain surgical operations were performed as follows： （1） 64 wounds were closed with suture; （2） 300 wounds were treated with free skin grafting; （3） 42 wounds were covered with various tissue flaps; （4） 31 wounds were performed xenoskin covering, vacuum drainage and debridement. Among them, 125 wounds were performed reoperation including 71 wounds of planned reoperation and 54 wounds of non-planned reoperation. Non-planned reoperation rate in special burns wound group was lower than both thermal burn wound group and non-burns wound group （ P 〈 0.01 ）. Both planned and non-planned reoperation rate of refractory wound group were higher than that of non-refractory wound group （ P 〈 0.01 ）. 5 sutured wounds healed through 7 times reoperation and ot

关 键 词：烧伤 创面 深度 修复外科手术 皮片移植 外科皮瓣 伤口愈合 

分 类 号：R644[医药卫生—外科学]