Gallup D C, Gallup D G, Nolan T E, Smith R P, Messing M F, Kline K L
Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA.
Am J Obstet Gynecol. 1996 Aug;175(2):358-61; discussion 362. doi: 10.1016/s0002-9378(96)70146-1.
The purpose of this study was to evaluate the effect of subcutaneous closed drainage systems and prophylactic antibiotics on the wound breakdown rate in obese patients undergoing gynecologic surgery.
A prospective study was performed on 197 obese patients who were randomly selected to have a subcutaneous drain. Incision closure technique was standardized. Antibiotic usage was not randomized. Demographic data, perioperative data, and postoperative complications were noted and analyzed by X2 test and 2 x 2 contingency tables.
The overall complication rate was 25%, with 20% (22/109) among the group receiving a drain versus 31% (27/88) without a drain. Seventeen patients (8.6%) had wound breakdowns: 7 of 109 (6.4%) with drains and 10 of 88 (11.4%) without drains. Prophylactic antibiotics were given to 46% (50/109) in the drain group and 51% (45/88) without a drain. Fewer patients (2%) with a drain receiving antibiotics had wound breakdowns. The group with the most breakdowns had neither a drain nor antibiotics (14%).
We suggest the use of subcutaneous drains plus prophylactic antibiotics may decrease morbidity when operating on obese gynecologic patients.
本研究旨在评估皮下封闭引流系统和预防性抗生素对接受妇科手术的肥胖患者伤口裂开率的影响。
对197例随机选择进行皮下引流的肥胖患者进行了一项前瞻性研究。切口闭合技术标准化。抗生素使用未随机化。记录人口统计学数据、围手术期数据和术后并发症，并通过X2检验和2×2列联表进行分析。
总体并发症发生率为25%，接受引流组为20%（22/109），未接受引流组为31%（27/88）。17例患者（8.6%）出现伤口裂开：接受引流的109例中有7例（6.4%），未接受引流的88例中有10例（11.4%）。引流组46%（50/109）和未引流组51%（45/88）接受了预防性抗生素治疗。接受抗生素治疗的引流患者中伤口裂开的较少（2%）。伤口裂开最多的组既未使用引流也未使用抗生素（14%）。
我们建议，对肥胖妇科患者进行手术时，使用皮下引流加预防性抗生素可能会降低发病率。
