微创联合负压创面治疗技术在颈淋巴结核外科治疗中的临床应用研究  

Clinical value of minimally invasive surgery and negative pressure wound therapy in surgical treatment of cervical lymphatic tuberculosis

作　　者：江涛[1] 薛丽京[2] 连贵勇[1] 周薇 薛宗锡[1] 肖泽林[1] 曾定科 高健齐[1] Jiang Tao;Xue Lijing;Lian Guiyong;Zhou Wei;Xue Zongxi;Xiao Zelin;Zeng Dingke;Gao Jianqi(First Division,Department of Surgery,Guangzhou Chest Hospital,Guangzhou 510095,China;Department of Pathology,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院外一科,510095 [2]广州市胸科医院病理科,510095

出　　处：《中华生物医学工程杂志》2021年第1期47-52,共6页Chinese Journal of Biomedical Engineering

基　　金：广东省医学科学技术研究基金立项资助(A2019290);广州市高水平临床重点专科和培育专科建设项目(穗卫函[2019]1555号);广东省转化医学创新平台培育建设项目B类(粤卫函[2018]1254号)。

摘　　要：目的:探讨应用微创联合负压创面治疗技术对颈淋巴结核外科治疗的疗效。方法:选择颈淋巴结核手术患者120例,按分组随机方式分为常规手术组(A组),常规手术+负压创面治疗组(B组),微创+负压创面治疗组(C组),每组各40例。A组和B组以常规手术方式行淋巴结核病灶清除术或区域性颈淋巴结清扫,C组以微创手术方式行淋巴结核病灶清除术或区域性颈淋巴结清扫。A组术后创面按常规放置纱块引流;B和C组术后创面采用负压创面技术治疗。全部病例在手术当天和术后第7天在创缘取组织,检测血管内皮生长因子(VEGF)和CD34的表达,比较三者在创口边缘VEGF和CD34的变化,比较手术时间,术中出血量,术后换药次数,伤口愈合时间,愈合瘢痕大小,术后住院时间。结果:术后第7天三组创缘标本VEGF阳性表达均有增加,CD34显示微血管计数均有增加,但B组和C组较A组增加更明显(P<0.05),B组和C组之间无差异(P>0.05);B组和C组术后换药次数和伤口愈合时间少于A组(P<0.05);术中出血量三组之间无差异(P>0.05);手术时间和术后住院时间B组和C组高于A组(P<0.05);C组术后瘢痕小于A组和B组(P<0.05)。结论:颈淋巴结核外科治疗采用微创能够使愈合的伤口瘢痕减少,术后采用负压创面治疗能够使创面VEGF,CD34表达增强,减少术后换药次数,加速伤口的愈合,但会增加手术和术后住院时间。Objective To investigate the therapeutic efficacy of minimally invasive surgery(MIS)and negative pressure wound therapy(NPWT)as surgical treatment for cervical lymphatic tuberculosis.Methods A total of 120 patients undergoing surgery for cervical lymphatic tuberculosis were recruited and randomized into conventional surgery group(group A),conventional surgery+NPWT group(group B),and MIS+NPWT(group C)(n=40 each).Groups A and B underwent local resection of the lymphoid tuberculosis lesions or regional neck lymph node dissection by conventional surgery,while the group C underwent local resection of the lymphoid tuberculosis lesions or regional neck lymph node dissection by MIS.After surgery,the wounds in group A were drained conventionally by gauze blocks,while those in groups B and C were managed with NPWT.In all patients,tissue samples were taken from the wound margin on the day of surgery and at 7 days after surgery to examine the expression of vascular endothelial growth factor(VEGF)and CD34.The three groups were compared for the changes in VEGF and CD34 expression at the wound margin,the operation time,intraoperative blood loss,frequency of dressing changes after surgery,time to wound healing,size of wound scar,postoperative length of hospital stay.Results At 7 days after surgery,the three groups showed increases in positive VEGF expression and CD34-positive microvessel counts in the wound margin specimens,but the increases in groups B and C were more significant than that in group A(P<0.05),and there were no differences between groups B and C(P>0.05).The frequency of dressing changes and time to wound healing after operation was lower or shorter in groups B and C than those in group A(P<0.05).There was no difference in intraoperative blood loss among the three groups(P>0.05).The operation time and postoperative length of hospital stay was longer in groups B and C than those in group A(P<0.05).The size of postoperative scar was smaller in group C than those in groups A and B(P<0.05).Conclusion Minimally invasiv

关 键 词：颈淋巴结结核 微创 负压创面治疗技术 伤口愈合 生长因子 

分 类 号：R653[医药卫生—外科学]