慢性伤口癌变筛查结果分析及干预方法的初步探讨  

Malignant changes of chronic wounds: Screening and intervention

作　　者：蒋琪霞[1] 王建东[2] 周济宏[3] 彭青[1] 黄秀玲[1] 周昕[1] 王海[2] 李晓华[1] 李洋[1] 

机构地区：[1]南京军区南京总医院门诊部,南京医学硕士210002 [2]南京军区南京总医院病理科,南京210002 [3]南京军区南京总医院烧伤整形科,南京210002

出　　处：《医学研究生学报》2015年第10期1053-1056,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81371611);南京军区科技创新课题(14MS103);南京军区南京总医院科研基金(2015071)

摘　　要：目的慢性伤口长期反复感染增加处理难度和癌变风险。文中旨在探讨慢性伤口癌变筛查方法、临床特征及干预方法,为临床及早发现和有效干预提供依据。方法入选2010年1月至2014年8月在南京军区南京总医院初诊为慢性伤口患者共358例,分为手术治疗组(n=78)和非手术治疗组(n=280),2组均包扎伤口使用银敷料抗感染,全身采用口入营养食谱、心理调适等整体干预方案,前者实施病灶切除和转皮瓣手术,2组干预观察期均为从伤口处理开始至第9周。观察指标包括癌变检出率、致病菌阳性率、癌变伤口愈合率等。结果 358例患者癌变检出率为6.70%,癌变伤口患者的持续时间中位数为352.50 d,癌变伤口类型构成比分别为不典型伤口(58.33%)、切口难愈(25%)、压疮(8.33%)、静脉性溃疡(4.17%)、外伤溃疡(4.17%)。致病菌阳性率67.32%,2组患者干预期内无死亡,伤口总愈合率差异无统计学意义(P=0.187),但手术治疗组癌变伤口愈合率高于非手术治疗组(75.00%vs 37.50%,P=0.040)。结论长期感染是诱发慢性伤口癌变的可能原因,手术治疗是癌变伤口和引流不畅深部伤口的有效干预手段,非手术治疗是癌变伤口姑息治疗的可选方法和大部分未癌变伤口的有效干预方法。Objective Long-term repeated infection of chronic wounds adds to the difficulty of management and risk of cancerization. This article aimed to investigate the malignancy screening,clinical characteristics,and intervention strategies of chronic wounds in order to provide some evidence for the early detection and effective intervention of cancerization. Methods We allocated358 patients with chronic wounds to a surgical（ n = 78） a non-surgical treatment group（ n = 280）,both treated by application of silver dressing,oral nutrition and psychological adjustment,the former by lesion resection and skin flap transplantation in addition,both for9 weeks. We analyzed the rates of cancerization,pathogenic bacteria,and wound healing using the software SPSS16. 0. Results Among the 358 cases,cancerized wounds accounted for 6. 70%,including atypical wound（ 58. 33）,difficult healing（ 25%）,pressure sore（ 8. 33）,venous ulcer（ 4. 17）,and trauma ulcer（ 4. 17）,lasting for a median of 352. 50 days. No death occurred during the intervention. The healing rate of the malignant wounds was markedly higher in the surgical than in the non-surgical treatment group（ 75% vs 37. 50%,P = 0. 040）,but there were no statistically significant differences in the total healing rate between the two groups（ P = 0. 187）. Conclusion Long-term infection may be a cause of cancerization of chronic wounds. Surgical treatment is an effective intervention strategy for malignant wounds and benign wounds with tendon or bones exposure,while non-surgical treatment can be used as a palliative care method for malignant wounds and an effective intervention for most benign wounds.

关 键 词：慢性伤口 感染 癌变伤口 活检 细菌培养 

分 类 号：R473.6[医药卫生—护理学]