胸腹壁穿透性高压电烧伤的救治方法及其临床疗效  

Treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominalwall

作　　者：钟爱 云娇 李辰宇 赵田 张浩然 陈俊杰[1] Zhong Ai;Yun Jiao;Li Chenyu;Zhao Tian;Zhang Haoran;Chen Junjie(Department of Aesthetic Plastic and Burn Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院美容整形烧伤外科,成都610041

出　　处：《中华烧伤与创面修复杂志》2024年第8期732-739,共8页Chinese Journal of Burns And Wounds

基　　金：四川大学华西医院科技项目(HX-1-12302057)。

摘　　要：目的探讨胸腹壁穿透性高压电烧伤的救治方法及其临床疗效。方法该研究为回顾性观察性研究。2020年3月—2023年3月,四川大学华西医院收治6例符合入选标准的胸腹壁穿透性高压电烧伤男性患者,年龄42~57岁,其中1例患者胸腹壁缺损伴胃壁与膈肌穿孔坏死,2例患者胸腹壁缺损伴单纯胃壁穿孔坏死,3例患者单纯腹壁缺损伴小肠穿孔坏死。在急诊下联合美容整形烧伤外科与普外科和/或胸外科医师为患者制订急诊手术方案,对3例胃壁穿孔坏死患者行胃大部切除吻合,对其中1例伴膈肌穿孔坏死患者行坏死膈肌切除修补;对另外3例小肠穿孔坏死患者行坏死肠段切除吻合。对胸腹壁创面行Ⅰ期保守清创,大网膜覆盖修补腹壁缺损后,对胸腹壁创面行负压封闭引流(VSD)治疗。7 d后对胸腹壁创面行Ⅱ期彻底清创,于大网膜表面及其四周无皮肤覆盖创面移植牛脱细胞真皮基质,继续对胸腹壁创面行VSD治疗。7 d后停止VSD治疗,待创面新鲜肉芽组织生长良好后,行Ⅲ期股外侧网状刃厚皮片移植封闭胸腹壁创面,继续行VSD治疗7 d。记录Ⅰ期术后患者肠内营养恢复情况与腹腔感染等并发症发生情况、Ⅱ期术后开始湿敷换药至创面具备皮片移植条件时间、Ⅱ期术后开始湿敷换药至创面愈合期间创面分泌物标本微生物培养情况与创周情况、皮片成活情况、创面愈合时间,随访胃肠道症状及腹壁疝、瘢痕、功能障碍等发生情况。结果6例患者均于Ⅰ期术后2~4 d恢复肠内营养,未发生肠梗阻、吻合口瘘或者腹腔感染。Ⅱ期术后开始湿敷换药至创面具备皮片移植条件时间为8(6,12)d。Ⅱ期术后开始湿敷换药至创面愈合期间,1例患者创面分泌物标本微生物培养结果为阴沟肠杆菌,1例患者创面分泌物标本微生物培养结果为铜绿假单胞菌,其余4例患者创面分泌物标本微生物培养结果为阴性;患者均未�Objective To explore the treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominal wall.Methods This study was a retrospective observational study.From March 2020 to March 2023,six male patients with penetrating high-voltage electric burns to thoracoabdominal wall who met the inclusion criteria were hospitalized at West China Hospital of Sichuan University,aged 42 to 57 years.Among them,one patient had thoracoabdominal wall defects with perforation and necrosis of the gastric wall and diaphragm,two patients had thoracoabdominal wall defects with perforation and necrosis of the gastric wall alone,and three patients had abdominal wall defects with perforation and necrosis of the small intestine.In the emergency department,aesthetic plastic and burn surgery,general surgery,and/or thoracic surgery doctors jointly formulated an emergency surgery plan for the patients.Three patients with perforation and necrosis of the gastric wall underwent subtotal gastrectomy and anastomosis.One of them,who also had diaphragmatic perforation and necrosis,underwent resection of the necrotic diaphragm and repair.The other three patients with perforation and necrosis of the small intestine underwent resection and anastomosis of the necrotic intestinal segment.After debriding the thoracoabdominal wall wounds conservatively in stage Ⅰ and repairing the abdominal wall defects with greater omentum coverage,the thoracoabdominal wall wounds were treated with vacuum sealing drainage(VSD).Seven days later,a stage Ⅱ thorough debridement of the thoracoabdominal wall wounds was performed,and bovine acellular dermal matrix was transplanted onto the surface of the greater omentum and the surrounding skin wounds without skin coverage,and the VSD treatment of the thoracoabdominal wall wounds was continued.After 7 days,the VSD treatment was stopped,and after the fresh granulation tissue well developed in the wounds,a stage Ⅲ transplantation of meshed split-thickness skin graft from the lateral femur w

关 键 词：烧伤 电 外科手术 负压伤口疗法 胸腹壁穿透性损伤 脱细胞真皮基质 游离皮片 序贯疗法 多学科团队协作 

分 类 号：R647[医药卫生—外科学]