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负压伤口治疗对预防下消化道穿孔所致腹膜炎手术后手术部位感染的疗效:单机构经验

Efficacy of Negative-Pressure Wound Therapy for Preventing Surgical Site Infections after Surgery for Peritonitis Attributable to Lower-Gastrointestinal Perforation: A Single-Institution Experience.

作者信息

Danno Katsuki, Matsuda Chu, Miyazaki Susumu, Komori Takamichi, Nakanishi Megumi, Motoori Masaaki, Kashiwazaki Masaki, Fujitani Kazumasa

机构信息

1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan .

2 Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine , Suita, Osaka, Japan .

出版信息

Surg Infect (Larchmt). 2018 Oct;19(7):711-716. doi: 10.1089/sur.2018.134. Epub 2018 Sep 5.

Abstract

BACKGROUND AND PURPOSE

For patients at high risk, such as those with lower-gastrointestinal perforations, it is important to establish a preventive method that reduces the incidence of surgical site infections (SSIs) significantly. We applied negative-pressure wound therapy (NPWT) as part of a delayed primary closure approach to prevent SSIs. This study evaluated the value of this technique.

METHODS

We included prospectively 28 patients undergoing abdominal surgery for peritonitis caused by a lower-gastrointestinal perforation between May 2014 and November 2015. Historical controls comprised retrospective data on 19 patients who had undergone primary suturing for managing peritonitis incisions for a lower-gastrointestinal perforation from January to December 2013.

RESULTS

We found a significant association between the SSI incidence and the type of incision management (10.7% with NPWT and delayed closure vs. 63.2% with primary suturing; p < 0.001). There was no significant difference between the groups in the length of the hospital stay (22 days for NPWT and delayed closure vs. 27 days for primary suturing; p = 0.45). No severe adverse events were observed related to NPWT.

CONCLUSION

The use of NPWT and delayed primary closure was an effective measure for preventing SSI in patients undergoing abdominal surgery for peritonitis caused by lower-gastrointestinal perforation.

摘要

背景与目的

对于高风险患者,如下消化道穿孔患者,建立一种能显著降低手术部位感染(SSI)发生率的预防方法很重要。我们将负压伤口治疗(NPWT)作为延迟一期缝合方法的一部分来预防SSI。本研究评估了该技术的价值。

方法

我们前瞻性纳入了2014年5月至2015年11月期间因下消化道穿孔引起腹膜炎而接受腹部手术的28例患者。历史对照包括2013年1月至12月期间因下消化道穿孔性腹膜炎切口行一期缝合的19例患者的回顾性数据。

结果

我们发现SSI发生率与切口处理类型之间存在显著关联(NPWT及延迟缝合组为10.7%,一期缝合组为63.2%;p<0.001)。两组住院时间无显著差异(NPWT及延迟缝合组为22天,一期缝合组为27天;p = 0.45)。未观察到与NPWT相关的严重不良事件。

结论

对于因下消化道穿孔引起腹膜炎而接受腹部手术的患者,使用NPWT及延迟一期缝合是预防SSI的有效措施。

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