Hiram Polk Jr. MD, Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, Kentucky.
J Surg Oncol. 2020 Sep;122(3):480-486. doi: 10.1002/jso.25980. Epub 2020 Jun 7.
Surgical site infections (SSIs) lead to increased morbidity and cost. Negative-pressure wound therapy (NPWT) removes wound exudate and improves local blood flow, but its effect on SSI is unproven following hepatectomy and pancreatectomy. The aim of this trial was to evaluate the effect of NPWT on SSI in this population.
Patients were randomized to incisional NPWT or sterile island dressing following surgery. SSI predictive factors were recorded as well as patient comorbidities. Wound complications and type of SSI were recorded prospectively.
Forty patients received the standardized perioperative bundle. Twenty patients received sterile island: 11 hepatic and 9 pancreatic resections; 20 patients received NPWT: 11 hepatic and 9 pancreatic resections; 23 patients were male; mean age 60.8 years (SD ±10.3); mean BMI 31.7 (SD ±7.0). There were three incisional wound infections: two with sterile island, one with NPWT; six organ space infections: four sterile island and two NPWT. There were no significant differences in SSI rates between groups (P = .57).
NPWT does not improve SSI rates over simple sterile dressing following hepatectomy or pancreatectomy. Improvements in SSI must be directed toward organ-space infections, which are unaffected by NPWT.
手术部位感染（SSI）会导致发病率和成本增加。负压伤口治疗（NPWT）可清除伤口渗出物并改善局部血液流动，但在肝切除术和胰腺切除术之后，其对 SSI 的影响尚未得到证实。本试验旨在评估 NPWT 对该人群 SSI 的影响。
患者在手术后随机接受切口 NPWT 或无菌岛敷料。记录 SSI 的预测因素以及患者的合并症。前瞻性记录伤口并发症和 SSI 的类型。
40 名患者接受了标准化的围手术期治疗包。20 名患者接受了无菌岛：11 例肝切除术和 9 例胰腺切除术；20 名患者接受 NPWT：11 例肝切除术和 9 例胰腺切除术；23 名男性；平均年龄 60.8 岁（标准差±10.3）；平均 BMI 为 31.7（标准差±7.0）。有 3 例切口感染：2 例为无菌岛，1 例为 NPWT；6 例器官间隙感染：4 例为无菌岛，2 例为 NPWT。两组 SSI 发生率无显著差异（P=0.57）。
NPWT 不能降低肝切除术或胰腺切除术后单纯无菌敷料的 SSI 发生率。必须针对器官间隙感染进行 SSI 改善，而 NPWT 对此无效。
