后腹腔镜泌尿外科手术术后切口液化原因分析与防治  

Analysis and prevention of postoperative incision liquefaction in urology retroperitoneal laparoscopic operation

作　　者：李文钊[1] 刘明建[1] 吴保忠[1] 陈深泉[1] Li Wenzhao;Liu Mingjian;Wu Baozhong(Department of Urology,the Second People's Hospital of Zhaoqing,Zhaoqing 526060)

机构地区：[1]广东省肇庆市第二人民医院泌尿外科,526060

出　　处：《中国现代医药杂志》2017年第3期40-43,共4页Modern Medicine Journal of China

摘　　要：目的分析后腹腔镜泌尿外科手术术后切口液化的原因及探讨防治方法。方法在2010年6月~2016年12月行后腹腔镜泌尿外科手术患者中,选取肥胖、糖尿病及/或低蛋白血症的基础疾病、手术时间超过90min和穿刺口直径>15mm以及除外上述条件的手术患者(作对照组)各92例,对术后出现切口液化的比例与对照组进行比较,分析切口液化原因并对围手术期处理和术后切口处理进行回顾性总结。结果 460例腹腔镜手术患者中有23例在术后第5~7天出现腹腔镜穿刺口脂肪液化,其中肥胖患者术后出现切口液化率最高,达9.8%。肥胖患者组及基础疾病患者组的切口液化率与对照组比较差异有统计学意义(χ~2=3.725,χ~2=3.107;P<0.05);而手术时间超过90min组和穿刺口直径>15mm组患者切口液化率与对照组比较差异无统计学意义(χ~2=1.645,χ~2=1.864;P>0.05)。经治疗17例在10d内愈合;4例切口肉芽组织新鲜行Ⅱ期缝合;2例合并切口感染,予引流后愈合。全部治愈出院,无伤口裂开,无切口疝发生。结论后腹腔镜手术切口较开放手术小,切口液化发生率低,但仍有部分患者出现切口液化,这与皮下脂肪厚度、基础疾病等因素有关;做好围手术期合理的切口护理,保持切口清洁,防治感染,可减少切口出现液化及缩短切口愈合期。Objective To analyze the cause of incision liquefaction and discuss the strategies of prevention and handle with incision liquefaction after retroperitoneal laparoscopic operation in urology. Methods 460 cases of laparoscopic operation in our urology department were analyzed retrospectively from Jun 2010 to Dec 2016. Each of the 92 cases of obesity,diabetes and/or hypoproteinemia underlying diseases,operation time more than 90 minutes,puncture diameter>15mm and except for the above conditions(control group)were selected,the postoperative incision liquefac?tion ratio was compared with the control group.Analysed the causes of incision liquefaction,reviewed the perioperation period treatment and incision processing. Results Among 460 patients undergoing laparoscopic surgery,23 cases occurred puncture mouth incision liquefaction 5~7 days after the laparoscopic operation.The incidence of incision liquefaction was the highest in obese patients,up to 9.8%.Compared with the control group,there was significant difference in incision liquefaction rate in the obese patients and the patients with underlying diseases(χ2=3.725,χ2=3.107;P <0.05).However,compared with the control group,there was no significant difference in incision liquefaction rate in the patients whose operation time was more than 90 minutes and the notch diameter was more than 15mm(χ2=1.645,χ2=1.864;P >0.05).After treatment,17 cases were healed within 10 days,4 cases whose wound granulation tissue was fresh accepted Ⅱ suture,2 cases with incision infection were healed after drainage.All the patients were cured,no wound dehiscence and incisional hernia occurred. Conclusion Compared with open surgery,retroperitoneal laparoscopic operation has smaller incision and lower incidence of incision liquefaction,but some patients'incision still occured liquefaction,this may be associated with thickness of subcutaneous fat,underlying diseases and other factors.Making reasonable nursing of incision,keeping incision tidy,preventing infection can decrease incision li

关 键 词：后腹腔镜手术 切口液化 防治 

分 类 号：R699[医药卫生—泌尿科学]