Department of Surgery, Minami Wakayama Medical Center, Wakayama, Japan.
Surg Infect (Larchmt). 2010 Dec;11(6):501-3. doi: 10.1089/sur.2009.072. Epub 2010 Sep 17.
Superficial surgical site infection (SSI) can be caused by bacterial invasion during surgery. We investigated whether bacteria are found at the wound margin during surgery and whether a wound protector (WP; Alexis® Wound Retractor; Applied Medical, Rancho Santa Margarita, CA) contributes to preventing invasion of the incision margin.
We studied 272 patients who underwent gastrointestinal surgery (115 gastric, 157 colorectal, including emergency operations) between October 2005 and July 2007. The WP was used in all operations. After the intra-abdominal procedures were complete, bacterial swabs were taken from the abdominal cavity side of the WP and from the incision margin and used to prepare smears and cultures. After the swabbing, peritoneal lavage was performed using 3,000-5,000 mL of physiologic saline, and, after suture of the fascia, 500-1,000 mL of physiologic saline was used to irrigate the subcutaneous tissue.
Nine gastric surgery patients and 15 colorectal surgery patients had positive cultures from the abdominal cavity. No patients had positive cultures from the incision margin. Of the 24 patients with positive cultures, three suffered SSIs, all of whom had undergone colorectal surgery. Of the patients who had negative cultures, SSI occurred in only one patient, who had undergone colorectal surgery.
These results suggest that the WP protects an incision site from bacterial invasion.
浅表手术部位感染（SSI）可由手术期间的细菌入侵引起。我们研究了手术过程中是否在伤口边缘发现细菌，以及伤口保护器（WP；Alexis® 伤口牵开器；Applied Medical，Rancho Santa Margarita，CA）是否有助于防止切口边缘入侵。
我们研究了 2005 年 10 月至 2007 年 7 月期间接受胃肠手术的 272 名患者（115 例胃手术，157 例结直肠手术，包括急诊手术）。所有手术均使用 WP。完成腹腔内手术后，从 WP 的腹腔侧和切口边缘采集细菌拭子，并用于制备涂片和培养。擦拭后，使用 3000-5000mL 生理盐水进行腹腔灌洗，在缝合筋膜后，使用 500-1000mL 生理盐水冲洗皮下组织。
9 例胃手术患者和 15 例结直肠手术患者的腹腔培养阳性。没有患者的切口边缘培养阳性。在 24 例培养阳性的患者中，有 3 例发生 SSI，均接受结直肠手术。在培养阴性的患者中，仅 1 例接受结直肠手术的患者发生 SSI。
这些结果表明 WP 可保护切口免受细菌入侵。
