负压封闭引流术在腹部手术后低位肠瘘治疗中应用.docVIP

负压封闭引流术在腹部手术后低位肠瘘治疗中应用 　　[摘要] 目的 探讨负压封闭引流术（VSD）在腹部手术后低位肠瘘治疗中的效果。方法 方便选取2010年12月―2015年12月该院收治的腹部手术后低位肠瘘患者18例，均应用VSD治疗，对其临床资料进行回顾性分析。结果 17例低位肠瘘患者经VSD治疗7～40 d后肠瘘愈合拔管，拆除VSD装置；1例患者经治疗瘘口反复不愈合，半年后再次手术治疗。治疗有效率94.4%。 结论 VSD在腹部手术后低位肠瘘治疗上安全有效，可缩短治疗时间，并发症少，临床效果好，值得临床应用推广 [关键词] 负压封闭引流术；腹部手术；低位肠瘘 [中图分类号] R656.6 [文献标识码] A [文章编号] 1674-0742（2017）01（b）-0062-03 [Abstract] Objective To discuss the effect of vacuum sealing drainage in treatment of low intestinal fistulas after the abdominal operation. Methods 18 cases of patients with low intestinal fistulas after the abdominal operation admitted and treated in our hospital from December 2010 to December 2015 were convenient selection， and were treated with VSD， and the clinical data were retrospectively analyzed. Results In the 17 cases of patients with low intestinal fistulas， after VSD treatment from 7～40 d， the intestinal fistula was cured and the VSD device was removed， and the orificium fistulae of 1 case was not cured， and the operative treatment was conducted after half a year， and the treatment effective rate was 94.4%. Conclusion The VSD treatment for low intestinal fistulas after the abdominal operation is safe and effective， which can shorten the treatment time with fewer complications and good clinic effect， which can be promote and applied in clinic. [Key words] Vacuum sealing drainage； Abdominal operation； Low intestinal fistulas 腹部手术后肠瘘占所有肠瘘的90%以上，是腹部外科手术中最严重的并发症，病死率可达15%～20%[1-3]。常规处理方法为营养支持、腹腔及全身感染控制、充分腹腔引流、切口换药及手术治疗。常规治疗愈合时间长，患者痛苦，腹腔及切口反复感染、并发症多，医护人员工作量大。肠瘘又有高位、低位之分。低位肠瘘是指距Treiz韧带100 cm以下的肠段发生瘘，?m然低位肠瘘不像高位肠瘘会在短时间内因病理生理的改变而危及生命，但如果处理不当产生的后果亦可致命[4]。该院于2010年12月―2015年12月应用负压封闭引流（vacuum sealing drainage，VSD）治疗腹部手术后低位肠瘘18例，效果满意，现报道如下 1 资料与方法 1.1 一般资料 该研究方便选取该院收治腹部手术后低位肠瘘18例作为研究对象，其中男性10例，女性8例；年龄23～78岁，平均（53.8±8.1）岁。原发病：直肠癌5例，结肠癌3例，腹部外伤结直肠损伤3例，低位较窄性肠梗阻2例，阑尾周围脓肿1例，腹股沟疝并回肠嵌顿坏死1例，小肠扭转坏死1例，急性坏疽性阑尾炎1例，克罗恩病1例。出现肠瘘时间为术后2～8 d。18例患者一般资料详情见表1 1.2 诊断及治疗方法 1.2.1 诊断 腹部手术后患者出现腹膜炎症状、不明原因发热或切口、引流管有粪水样液溢出，应考虑肠瘘可能[5