骶尾部放射性溃疡诊治1例  

One Case of Repair Strategy for Chronic Sacrococcygeal Radiation Ulcer

作　　者：张薇 王爽[1] 张静琦[1] 李小兵[1] ZHANG Wei;WANG Shuang;ZHANG Jingqi;LI Xiaobing(Department of Burn and Plastic Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院整形与烧伤外科,天津300192

出　　处：《继续医学教育》2021年第9期80-82,共3页Continuing Medical Education

摘　　要：放射性溃疡具有潜在性、进展性,创面大小不一,经久不愈的特点。放射性溃疡需2期治疗,骶尾部的放射性溃疡常见于直肠癌术后的放疗。病例特点:直肠癌术后放疗引起骶尾部慢性创面长期不愈达13年,将近10年左右创面范围无明显改变,自行定期换药,后继发大腿感染性窦道伴大腿的疼痛。放疗损伤同时长期慢性炎症导致创面周围组织纤维化、血运差,组织活性低难以愈合。病例的治疗思路为分2期修复,Ⅰ期创面床的准备包括合理的清创及创面负压冲洗治疗,Ⅱ期需皮瓣修复,填充组织缺损的同时保证创面修复后的功能的保留。Radiation ulcers are latent,progressive,wounds vary in size,and take a long time to heal.Radiation ulcers require two-stage treatment.Chronic sacrococcygeal radiation ulcers are common in postoperative radiotherapy for rectal cancer.The characteristics of this case:postoperative radiotherapy for rectal cancer caused chronic sacrococcygeal radiation ulcer that did not heal for 13 years,and the wound had no obvious changes in the range of the wound for nearly 10 years,and the wound was changed regularly by patient’s son,subsequent there was Infectious sinus of the left thigh.Radiotherapy injury and long-term chronic inflammation lead to tissue fibrosis around the wound,poor blood supply,and low tissue activity,which make it difficult to heal.The repair strategy of this case is the two-stage treatment.The standard of the first-stage wound bed includes reasonable debridement and negative pressure washing of the wound.The second-stage requires myocutaneous flaps to fill the tissue defect while ensuring the preservation of the function of the wound after repair.

关 键 词：放射性溃疡 VSD负压封闭引流 臀大肌皮瓣 富血小板血浆 

分 类 号：R644[医药卫生—外科学]