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  

Clinical Comparison of Temporary Abdominal Closure and Conventional Abdominal Closure in the Treatment of Severe Abdominal Infection

作　　者：陈帆[1] 朱宏亮[1] 钱洪军[1] 易伟[1] 谢先强 

机构地区：[1]中国人民解放军第九四医院普外科,南昌330002

出　　处：《中国微创外科杂志》2015年第7期628-631,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的观察暂时性腹腔关闭（temporary abdominal closure,TAC）与常规关腹技术在严重腹腔感染中的临床效果。方法回顾性分析2010年3月-2014年7月15例严重腹腔感染的临床资料,其中8例采用负压封闭引流关闭系统（vacuum sealing drainage,VSD）行暂时性关腹,7例常规关腹。比较2组术后腹内压变化、创面愈合时间、术后并发症等。结果常规关腹组术后72 h内腹内压逐渐升高,术后6-72 h各监测的时间点均高于暂时性关腹组（P〈0.01）。暂时性关腹组术后腹内压变化相对平稳（波动在7.7-18.1 mm Hg之间）,创面愈合早[（11.3±1.8）d vs.（19.4±6.7）d,t=-3.142,P=0.005],切口感染少[12.5%（1/8）vs.100%（6/6）,P=0.005]。结论暂时性腹腔关闭技术在治疗严重腹腔感染中能有效地预防腹内压升高,促进创面愈合,减少术后并发症,疗效确切。Objective To observe the clinical effect of temporary abdominal closure（ TAC） and conventional abdominal closure technology for severe abdominal infection. Methods A retrospective analysis was made on the clinical data of 15 cases of severe abdominal infection treated from March 2010 to July 2014,during which there were 8 cases of temporary abdominal closure and7 cases of conventional abdominal closure. The change of intra-abdominal pressure,the healing time of wound surface and the postoperative complications were compared respectively between the two groups. Results For conventional abdominal closure,the postoperative intra-abdominal pressure was increased gradually within 72 hours,with pressure at all observation time points within 6-72 hours higher than the temporary abdominal closure（ P〈0. 01）. In the temporary abdominal closure group,the change of intraabdominal pressure was relatively stable,the healing time of wound surface was faster [（ 11. 3 ± 1. 8） d vs.（ 19. 4 ± 6. 7） d,t =-3. 142,P = 0. 005 ],and the incision infection was fewer [12. 5%（ 1 /8） vs. 100%（ 6 /6）,P = 0. 005]. Conclusion Temporary abdominal closure technology could effectively reduce the intra-abdominal pressure,promote wound healing,and reduce postoperative complications in the treatment of severe abdominal infection,with definite curative effects.

关 键 词：负压封闭引流关闭系统 暂时性腹腔关闭术 严重腹腔感染 腹腔内高压 

分 类 号：R656[医药卫生—外科学]