负压伤口治疗在结直肠手术中预防手术部位感染的作用。
Role of negative pressure wound therapy in the prevention of surgical site infection in colorectal surgery.
作者信息
Ocaña Jiménez Juan, Abadía Barno Pedro, Ramos Rubio Diego, Pina Hernández Juan Diego, García Pérez Juan Carlos, Moreno Montes Irene, Rodríguez Velasco Gloria, Tobaruela de Blas Estela, Die Trill Javier
机构信息
Cirugía General y Digestivo, H.U. Ramón y Cajal, Madrid, España.
Cirugía General y Digestivo, Unidad Coloproctología, H.U. Ramón y Cajal, Madrid, España.
出版信息
Cir Esp (Engl Ed). 2019 May;97(5):268-274. doi: 10.1016/j.ciresp.2019.03.001. Epub 2019 Apr 10.
BACKGROUND
Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives.
METHODS
We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol.
RESULTS
No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93).
CONCLUSIONS
NPWT is a useful SSI prevention treatment in colorectal surgery.
背景
手术部位感染（SSI）是结直肠手术中最常见的并发症之一。在10% - 20%的结直肠手术中会被诊断出该并发症。负压伤口治疗（NPWT）已显示出在治疗慢性和创伤性伤口、伤口裂开、皮瓣和移植物方面的有效性。本研究的主要目的是评估NPWT在预防结直肠手术中SSI的效果。减少住院时间和SSI风险因素是次要目的。
方法
我们开展了一项前瞻性病例对照研究，纳入了2017年接受结直肠诊断和手术（择期和非择期）的80例患者。40例患者接受了为期一周的预防性NPWT治疗。40例患者按照标准的术后手术伤口护理方案进行治疗。
结果
在人口统计学变量、合并症、手术方式、择期或非择期手术、机械性肠道准备和手术过程方面未发现显著差异。NPWT组有3例患者发生SSI（8%）（95%置信区间0 - 17.5）。对照组有10例患者发生SSI（25%）（95%置信区间12.5 - 37.5）（p = 0.034）；比值比为0.7（95%置信区间0.006 - 0.964）。NPWT组的住院时间为8天，而非NPWT组为12天（p = 0.22）。在多变量分析中，发现机械性肠道准备是SSI的唯一风险因素（p = 0.047；比值比：0.8，置信区间0.45 - 0.93）。
结论
NPWT是结直肠手术中预防SSI的一种有效治疗方法。
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