Bartos Gábor, Markovics Gabriella, Várföldi Tamás, Buzáné Kis Piroska
Szent Pantaleon Kórház Altalános Sebészeti Osztály Dunaújváros Tamási Aron u. 43. 2400.
Orv Hetil. 2009 Feb 1;150(5):209-15. doi: 10.1556/OH.2009.28429.
Investigation of the incidence of wound healing disorders in operative material and that of possible commonality with the nosocomial categories of operations and with the surgical site infections registered by the authors, respectively. OPERATIVE MATERIAL AND METHOD: The data of 33,336 operations, made in their ward, are analysed by the authors. By way of introduction the question of nomenclature is discussed which is not uniform in the literature. Referring to the most accepted infection surveillance systems they state that wound healing disorders represent a different idea than surgical site infections. The method of their prospective investigation is described as follows: at the time of the emission of the patient every wound healing disorder is registered in a collective protocol and in a short case history. Then they are monthly summarised. The data were elaborated in one year, in 5 years, in 10 years and in 20 years grouping interconnected with the nosocomial categories of the operations, and with the surgical site infections observed in the same period of time.
The numerical results are debated in detail. These show that the 20-year summarised rate of wound healing disorders amounts to 2.2% and that of surgical site infections to 2.7%. They point out that the rates of both wound healing disorders and surgical site infections are diminishing during the second half of observation. The former is related to the improved surgical technique and to the better operative circumstances introduced during the observed two decades. The latter can be a consequence of their prospective infection register based on the CDC ad HELICS systems.
Up till now no information could be found by them in the literature concerning the interaction of wound healing disorders with the nosocomial categories of the performed operations. The author's new establishment: as proceeding from category "A" towards category "D", not only the rates of surgical site infections became greater and greater, but those of wound healing disorders, too. But there is an important difference: the increase of the rates of wound healing disorders is in general meaningfully less than that of surgical site infections. Concerning the interaction of wound healing disorders with surgical site infections also another original observation was made by them: if the rate of surgical site infections is less than 2%, the identical rate of wound healing disorders is greater than the rate of surgical site infections and vice versa. If the rate of surgical site infections is greater than 2%, the rate of wound healing disorders becomes less than the rate of site infections. In conclusion the authors think that this relationship between the two sorts of rates - which can be seen in the majority (82.5%) of the rates of wound healing disorders and identical surgical site infections - seems to be fundamental. The interpretation of this observation can be done as follows: all wound healing disorders represent "loci minoris resistentiae" concerning the infection. They don't suppurate, or they scarcely suppurate in the aseptic category "A" and in the facultative septic category "B". On the other hand, more and more of their proportion becomes suppurated in the septic category "C", and even more in the seriously septic category "D". Finally they refer to their guessing, whereby, in an adequate context, the rates of wound healing disorders could be perhaps new indicators in surgical quality assurance.
分别调查手术材料中伤口愈合障碍的发生率，以及与作者记录的医院内手术类别和手术部位感染的可能共性。
作者分析了在其病房进行的33336例手术的数据。作为引言，讨论了文献中不统一的命名问题。参照最被认可的感染监测系统，他们指出伤口愈合障碍与手术部位感染代表不同的概念。他们前瞻性调查的方法如下：在患者出院时，每例伤口愈合障碍都记录在一份汇总协议和一份简短的病历中。然后每月进行汇总。数据按与医院内手术类别以及同期观察到的手术部位感染相关联的分组方式，分别在1年、5年、10年和20年进行整理。
详细讨论了数值结果。这些结果表明，20年汇总的伤口愈合障碍发生率为2.2%，手术部位感染发生率为2.7%。他们指出，在观察的后半期，伤口愈合障碍和手术部位感染的发生率都在下降。前者与手术技术的改进以及观察的二十年中引入的更好的手术环境有关。后者可能是基于美国疾病控制与预防中心（CDC）和HELICS系统的前瞻性感染登记的结果。
到目前为止，他们在文献中未找到关于伤口愈合障碍与所进行手术的医院内类别之间相互作用的信息。作者的新发现：从“A”类手术到“D”类手术，不仅手术部位感染的发生率越来越高，伤口愈合障碍的发生率也是如此。但有一个重要区别：伤口愈合障碍发生率的增加总体上明显低于手术部位感染发生率的增加。关于伤口愈合障碍与手术部位感染的相互作用，他们还进行了另一项原始观察：如果手术部位感染的发生率低于2%，相同的伤口愈合障碍发生率高于手术部位感染发生率，反之亦然。如果手术部位感染的发生率高于2%，伤口愈合障碍的发生率则低于手术部位感染的发生率。总之，作者认为这两种发生率之间的这种关系——在大多数（82.5%）伤口愈合障碍发生率和相同手术部位感染发生率中都可见——似乎是根本性的。对这一观察结果的解释如下：所有伤口愈合障碍在感染方面都代表“抵抗力较弱的部位”。在无菌的“A”类和兼性感染的“B”类中，它们不化脓或几乎不化脓。另一方面，在感染的“C”类中，它们化脓的比例越来越高，在严重感染的“D”类中更高。最后，他们提到了自己的猜测，即在适当的背景下，伤口愈合障碍的发生率可能成为手术质量保证的新指标。
