负压封闭引流在颌面外科术后严重颌面颈部感染的应用  

Application of vacuum sealing drainage in severe maxillofacial and neck infections after oral and maxillofacial surgery

作　　者：龙静 黄谢山[1] 潘小萌[1] 陈灼庚 Long Jing;Huang Xieshan;Pan Xiaomeng;Chen Zhuogeng(Hainan Stomatology Center,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院口腔医学中心颌面外科.海南省口腔医学中心,海口570208

出　　处：《中华口腔医学研究杂志（电子版）》2018年第5期294-298,共5页Chinese Journal of Stomatological Research(Electronic Edition)

摘　　要：目的探讨应用持续负压封闭引流技术(VSD)治疗口腔颌面外科术后经持续换药后未见明显好转、且呈持续性加重的颌面颈部感染的疗效。方法采用VSD治疗8例口腔颌面外科术后经持续换药未见好转、且呈持续性加重的严重颌面颈部感染,在去除术后感染区坏死物质、彻底清创后,以负压封闭引流材料覆盖创口,0.9%氯化钠溶液冲洗,持续负压引流,直至引流液清亮、创缘组织无红肿、无压痛后,撤除VSD装置。结果 6例患者明确感染后,使用传统换药约7～8 d,感染呈进行性加重,遂使用VSD装置置于感染区,持续引流5～15 d后,可见引流液清亮,颌面部肿胀基本消失,创缘周围可见肉芽组织增生,伤口基本愈合;所有病例中有1例为放射性颌骨骨髓炎行腓骨肌皮瓣修复,明确感染、持续换药约20 d后,感染呈进行性加重,放置VSD 5 d后于手术室清除病灶骨,术后继续换药,伤口愈合;1例术后并发食管瘘患者使用VSD时间长,撤除VSD后,引流液清亮,颌面部肿胀较前明显减轻,创口可见肉芽组织增生,但左颈部仍可见到1个大小约1 cm×1 cm的瘘管,邻近瘘管可见颈部膨隆明显,扪诊质硬,无波动感。左颈部磁共振成像(MRI)增强示:左颈部见3.9 cm×2.3 cm×5.0 cm大小的不规则占位病变,右颈部见1个大小约2.3 cm×1.4 cm团块状病变,考虑淋巴结肿大(术后复发)。结论 VSD有利于控制感染,防止术后感染扩散,促进术后创面组织的愈合;同时肿瘤患者使用VSD存在促癌细胞转移、增殖的可能,在应用过程中应充分考虑其适应证,并密切监测创区变化,当发现可疑病变或创面延迟愈合时,应立即撤除VSD装置,根据具体情况行进一步治疗。Objective To observe the effect of continuous negative pressure drainage vacuum sealing drainage(VSD)in the treatment of aggravated postoperative infection in maxillofacial and cervical area.Methods VSD was used to treat severe maxillofacial infection in 8 cases after oral and maxillofacial surgery which had not been improved and continued to be aggravated.After removal of the necrotic substance and comprehensive debridement in the postoperative infection,the wound was covered with vacuum sealing drainage materials washed by 0.9%Sodium Chloride Solution,and drainaged by the continuous negative pressure.The VSD device was removed until the drainage fluid was clear and the wound tissue was free from swelling and tenderness.Results After a clear infection of the 6 cases and traditional exchange was used about 7-8 days,the infection was not improved but progressively aggravated.Then the VSD device was placed in the infection area.After 5-15 days′continuous drainage,the drainage fluid was clear while the swelling of the maxillofacial region disappeared basically,and proliferation of the granulation tissue was seen around the wound and all the wounds healed basically.In one case,the patient was diagnosed as radioactive osteomyelitis of the jaws and repaired with fibular myocutaneous flap.After definite infection and 20 days′continuous change of medicine,the infection showed progressive aggravation.After placing VSD for 5 days in the operation area,the focal bone was cleared in operating room.After the operation,we continued to change the fresh dressing on the wound,and the wound was healed.One case of postoperative patients with esophageal fistula used the VSD for a long time.After removal of VSD,the drainage fluid was clear,and the swelling of the maxillofacial region was lightened and granulation tissue hyperplasia was seen around the wound.But we could still see a 1 cm×1 cm fistula on the left neck.MRI enhancement in the left neck showed an irregular occupying lesion of the 3.9 cm×2.3 cm×5.0 cm size in the le

关 键 词：口腔外科手术 感染 负压封闭引流技术 持续换药 颌面颈部 

分 类 号：R782[医药卫生—口腔医学]