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Clinical Comparative Study of Tension-Free Herniorrhaphy with Different Suture

目的　觀察運用兩種不同縫線固定修補材料對疝修補術后的復發、切口感染、慢性疼痛等并發癥發生情況。方法　對2008年4月至2010年4月期間筆者所在科室收治的250例腹股溝疝患者行無張力疝修補手術時，采用多股絲線或可吸收合成縫線固定修補材料進行前瞻性對比研究。結果　2組患者術后疝復發、切口感染和切口疼痛（包括慢性疼痛）發生率間的差異均無統計學意義（P＞0.05）。結論　腹股溝疝無張力修補術后的復發、切口感染、慢性疼痛等并發癥的發生與縫線選擇無關。術者的操作技巧、嚴格的無菌操作原則、徹底止血以及組織損傷小才是防止術后感染、慢性疼痛等并發癥發生的重要因素。

Study on the Role of the Coated VICRYL Plus Antibacterial Suture in the Prevention of Infection of Appendectomy Incision

摘要:目的: 探討在闌尾切除術中應用抗菌薇喬縫線以減少闌尾切口感染的可能性。 方法 : 將我院2007年4月至2009年3月所有闌尾切除術病例1425例隨機分為抗菌薇喬縫線組和絲線組,比較其切口感染發生率。 結果 : 統計中按闌尾未穿孔、闌尾穿孔以及總計分別計算切口感染率,在抗菌微喬線組感染率分別為017%、072%、028%,絲線組分別為154%、781%、267%,兩組間分別予以X2檢驗,其〖WTBX〗P 值均小于001,具有顯著性差異。 結論 : 縫線是輔助產生切口感染的一個危險因素,在闌尾切除術中使用抗菌薇喬縫線可以顯著降低切口感染率。Abstract: Objective: To investigate the application of Coated VICRYL Plus Antibacterial suture in order to reduce the possibility of infection of appendectomy incision. Methods : Hospital from April 2007 to March 2009 appendectomy patients in all 1425 cases were randomly divided into Coated VICRYL Plus Antibacterial suture group and silk group,compared to the incidence of incision infection. Results : The statistics are not in accordance with perforated appendicitis, perforated appendicitis, as well as calculation of the total, respectively, incision infection, the infection rate in the Coated VICRYL Plus Antibacterial suture group were 017%, 072%, 028%, silk group were 154%, 781%, 267% between the two groups separately X2 test, the P value of less than 001, with a significant difference. Conclusion : The suture is to assist the incision produced a risk factor for infection in appendectomy,Coated VICRYL Plus Antibacterial suture can be used in a significant reduction in incision infection rates.

Risk Factors for Incision Infection in Gastrointestinal Surgery and Its Preventive Measures

目的　分析胃腸外科手術切口感染的影響因素，為醫院感染的防治提供理論依據。 方法　回顧性分析2010年12月－2012年12月764例行胃腸外科手術患者的臨床資料，并用單因素χ2檢驗統計分析患者醫院感染的危險因素。 結果　共有65例患者發生手術切口感染，其感染率為8.5%，且分離培養出合格菌株48株，陽性率73.8%，其中G?菌32株，占66.7%，G+菌16株，占33.3%。G?菌主要以大腸桿菌、變形桿菌、克雷伯桿菌和腸桿菌為主，分別占29.2%、18.8%、12.5%和6.2%；G+菌以腸球菌和表皮葡萄球菌為主，分別占22.9%和10.4%。單因素χ2檢驗顯示年齡＞60歲、手術時間＞120 min、術中有輸血、且有腫瘤病變的患者具有較高的切口感染發生率（P＜0.05）。 結論　胃腸外科手術切口感染的主要致病菌是G?桿菌，患者的年齡、手術時間、術中輸血情況和疾病良惡性質是術后切口感染的高危因素，積極采取相應的預防措施有望減低其感染的發生率。

RECONSTRUCTION OF INFECTED MEDIAN STERNOTOMY WOUND DEHISCENCE AFTER CORONARY ARTERY REVASCULARIZATION

Objective To introduce the experience about thereconstruction of median sternotomy wound dehiscence. Methods From February 2002 to October 2004, 10 patients with median sternotomy wound dehiscence due to coronary artery revascularization were treated. There were 7 males and 3 females, aging from 68 to 76 years. The sizes of defects ranged from3 cm×5 cm to 5 cm×15 cm. After debridement of necrotic soft tissue, sternum and rib, infected median sternotomy wound was reconstructed with rectus abdominis myocutanous flap, pectoralis major myocutanous flap and latissimus dorsi flap or single muscle flap. The sizes of flaps ranged from 3 cm×5 cm to 5 cm×16 cm.Results Allpatients were followed up from 3 to 11 months with anaverage of 6 months. All the patients achieved healing by first intention with normal respiration and normal function of upper limbs. The wound of donor site healed well.No abdominal hernia and other complications occurred. The wound of donor site healed well.The results were satisfactory.Conclusion According to different stages of the disease and different conditions of an operation, the surgical management should vary with each individual.

Analysis of The Related Factors of Postoperative Wound Infection for Acute Appendicitis

目的 探討急性闌尾炎手術后切口感染的相關因素。方法 觀察我院2002年5月至2007年5月期間收治的665例急性闌尾炎患者采用術前預防使用抗生素、術中保護切口、術后加強切口管理等處理后切口感染情況，并分析切口感染與闌尾炎的病程、手術時間、切口選擇、留置引流和病理類型之間的關系。結果 本組患者中32例發生切口感染，感染率為4.81% (32/665)，急性闌尾炎術后切口感染與性別無關（ P ＞ 0.05），與病程長短、切口選擇、手術時間、腹腔留置引流與否以及病理類型均有關（ P ＜ 0.01）。結論 病程長、手術時間久、炎癥較重的急性闌尾炎病例切口感染率較高； 做好圍手術期的處理，術中盡量保護切口可以降低切口感染率。

Surgical treatment of 655 patients with deep chest wall infection: A single-center retrospective analysis

ObjectiveTo explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.MethodsThe clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.ResultsThe average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).ConclusionPedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.

Peutz-Jeghers綜合征腸套疊術后腸梗阻并發腸瘺妊娠患者護理一例

甲狀腺術后切口感染抗壞血酸克呂沃爾菌伴竇道經久不愈1例報道

目的探討甲狀腺術后切口感染及頸部竇道形成原因及臨床診治經驗。 方法回顧性分析筆者所在醫院收治的1例甲狀腺術后切口感染抗壞血酸克呂沃爾菌伴頸部竇道形成的臨床病例資料，并檢索國內外文獻以分析切口感染原因，總結臨床診治要點。 結果本例患者因結節性甲狀腺腫伴甲狀腺腺瘤在外院行甲狀腺雙葉次全切除術，術后發生切口感染及頸部竇道形成且經久不愈（4年），切口分泌物細菌培養為抗壞血酸克呂沃爾菌，遂收治于筆者所在醫院，在加強抗感染基礎上應用術中神經監測和精細化被膜外操作技術行竇道膿腔及基底部腺體組織一并切除術，術后11 d治愈出院，無并發癥發生，隨訪半年無復發。抗壞血酸克呂沃爾菌是一種不常見的條件致病菌，本例患者的感染可能系因異物置入所致。 結論甲狀腺手術應謹慎應用止血填充物；對于頸部竇道，手術徹底切除是唯一的治療手段；在高風險、復雜甲狀腺手術中應用神經監測技術、進行精細化被膜外操作，有助于保護喉返神經和甲狀旁腺，提高手術安全性。

INTRAABDOMINAL DRAINS AFTER APPENDECTOMYINCREASE RISK OF WOUND INFECTION

目的探討闌尾切除術后腹腔引流放置與否對切口感染的影響。方法回顧性分析1 719例闌尾手術的引流情況和切口感染情況。結果引流組切口感染率為50.93%，未引流組為3.17%(Plt;0.005)。其中單純性闌尾炎引流組感染率為33.33%，未引流組為1.66%； 化膿性闌尾炎引流組感染率為46.43%，未引流組為3.12%； 壞疽性闌尾炎引流組感染率為56.25%，未引流組為20.00%； 穿孔性闌尾炎引流組感染率為54.95%，未引流組為23.08%。結論無論何種類型闌尾炎，術后放置腹腔內引流均可能增加切口感染。

Clinical Analysis of Relative Factors of Postoperative Wound Infection in Acute Suppurative Appendicitis with Perforation

目的　探討急性化膿穿孔性闌尾炎術后切口感染的相關因素。方法　回顧性分析2009年1月至2011年6月期間我院普外科手術治療的化膿穿孔性闌尾炎161例患者的臨床資料。結果　161例患者中35例（21.7%）發生了切口感染。單因素分析結果表明，肥胖（體質指數＞30kg/m2）、手術時間超過1h、術前未預防性應用抗生素及術后首次切口換藥時間＞3d者切口感染發生率高（P＜0.05）；多因素分析結果表明，手術時間超過1h及術前未預防性應用抗生素是急性化膿穿孔性闌尾炎術后切口感染的獨立危險因素（P＜0.05）。結論　早期診治、降低手術時間、術前合理預防性應用抗生素有助于減少切口感染機會。