臀部反复复发化脓性汗腺炎慢性创面序贯治疗的临床疗效观察  

Clinical therapeutic observation on sequential treatment of chronic wounds with repeated recurrence of hidradenitis suppurativa in buttocks

作　　者：李志清[1] 温皇鼎 李胜龙[2] 牛利斌[1] 吴起[1] Li Zhiqing;Wen Huangding;Li Shenglong;Niu Libin;Wu Qi(Department of Burns,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Colorectal Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院烧伤科,广州510515 [2]南方医科大学南方医院肛肠科,广州510515

出　　处：《中华烧伤杂志》2019年第10期757-760,共4页Chinese Journal of Burns

基　　金：广东省科技计划(2014A020212184).

摘　　要：目的观察病灶广泛切除—负压封闭引流(VSD)联合含氧液冲洗—组织移植序贯治疗臀部多次术后仍反复发作化脓性汗腺炎(HS)慢性创面的临床疗效。方法2012年1月—2017年3月,笔者单位烧伤科收治符合入选标准的Hurley Ⅲ级且经2~5次手术仍反复发作的臀部HS男性患者15例(年龄26~53岁),对其进行前瞻性自身前后对照研究。先行病灶广泛切除,术后给予持续VSD联合间断含氧液冲洗,负压为-16.7 kPa,纯氧流量为1.0 L/min。VSD联合含氧液冲洗治疗7 d后拆除负压装置,行自体大腿后侧中厚皮片和/或局部皮瓣移植以修复创面,其中6例患者创面行中厚皮片移植,4例行局部皮瓣移植,5例行中厚皮片+局部皮瓣移植。局部皮瓣供瓣区直接缝合或移植自体大腿后侧中厚皮,中厚皮供皮区移植自体头部刃厚皮修复。于病灶切除前及VSD联合含氧液冲洗治疗7 d后留取创面组织或创基肉芽组织,行组织细菌培养,并采用酶联免疫吸附测定法检测组织中肿瘤坏死因子α(TNF-α)含量。观察术后皮片和皮瓣成活情况,记录住院时间,随访观察HS复发情况及并发症情况。对数据行配对样本t检验。结果本组患者病灶切除前创面组织细菌培养结果均为阳性,主要为葡萄球菌、链球菌、奇异变形杆菌和厌氧菌等;VSD联合含氧液冲洗治疗7 d后创面肉芽组织细菌培养结果均为阴性。本组患者VSD联合含氧液冲洗治疗7 d后创基肉芽组织TNF-α含量为(10.1±2.9)pg/L,较病灶切除前的(73.6±5.6)pg/L降低(t=33.47,P<0.01)。15例患者术后皮片和/或皮瓣移植均成活,创面愈合,住院17~31 d。随访1~5年,15例患者臀部手术部位HS均无复发;有1例患者术后因出现高位肛瘘致肛周愈合切口溃破,经治疗愈合。结论病灶广泛切除—VSD联合含氧液冲洗—组织移植的序贯治疗可较彻底清除臀部HS病灶、改善清创后创基受皮条件,从而有利于治愈临床历经多次手�Objective To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley′s stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results Bacterial culture result of wound tissue before lesion resection was positive in a

关 键 词：负压伤口疗法 汗腺炎 化脓性 氧 冲洗治疗 慢性创面 

分 类 号：R6[医药卫生—外科学] R758[医药卫生—临床医学]