García Gonzalez Miriam, Casal Beloy Isabel, Gómez Dovigo Alba, Miguez Fortes Lorena, Dargallo Carbonell Teresa, Pita-Fernández Salvador, Caramés Bouzán Jesús
Ostomy Wound Manage. 2017 Jun;63(6):34-38.
Necrotizing enterocolitis (NEC) is the most common surgical emergency in neonatal intensive care units, and patients who require surgery have high mortality and morbidity rates. The utility of negative pressure in the management of adults with complicated abdominal wounds has been documented, but there are few reports describing the use of negative pressure wound therapy (NPWT) in children or following neonatal surgery. The case of a 6 day old, 5-weeks premature neonate with NEC is presented. An exploratory midline laparotomy was performed on day 3 of life owing to rectal bleeding and abdominal distension that did not respond to gastric decompression, bowel rest, and intravenous antibiotics. Ten (10) cm of necrosis in the distal ileum were noted and resected; in addition, an ileostomy was performed, and a Penrose drain was left in the surgical site. On postoperative day 5, the laparotomy dehisced. Continuous NPWT (50 mm Hg) was initiated and changed owing to patient tolerance to intermittent therapy (5 minutes on, 30 seconds off) at 80 mm Hg. By postoperative day 11, granulation tissue formation was complete. No surgical procedures were required for the complete closure of the abdominal wall, and no adverse reactions were noted. The baby was discharged from the hospital on postop day 15. In this patient, the use of negative pressure was found to be safe and facilitated management of a complicated abdominal wound in the presence of a stoma and the formation of healthy granulation tissue. Additional research is needed to help clinicians provide optimal, evidence-based care for dehisced wounds in this vulnerable population.
坏死性小肠结肠炎（NEC）是新生儿重症监护病房中最常见的外科急症，需要手术治疗的患者死亡率和发病率都很高。负压在成人复杂腹部伤口处理中的作用已有文献记载，但很少有报告描述负压伤口治疗（NPWT）在儿童或新生儿手术后的应用。本文介绍了一名6天大、早产5周且患有NEC的新生儿病例。患儿出生第3天，因直肠出血和腹胀，经胃肠减压、肠道休息及静脉使用抗生素治疗无效，遂行中线剖腹探查术。术中发现回肠末端有10厘米坏死并予以切除；此外，还进行了回肠造口术，并在手术部位留置了一根橡皮引流管。术后第5天，剖腹手术切口裂开。开始持续NPWT（50毫米汞柱），后因患者耐受，改为间歇性治疗（开5分钟，关30秒），压力为80毫米汞柱。至术后第11天，肉芽组织形成完成。腹壁完全闭合无需再次手术，且未观察到不良反应。患儿于术后第15天出院。在该患者中，发现使用负压是安全的，有助于处理存在造口的复杂腹部伤口并促进健康肉芽组织的形成。需要进一步研究以帮助临床医生为这一脆弱人群的伤口裂开提供最佳的循证护理。
