中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔持续冲洗引流治疗肠瘘合并腹腔感染的临床疗效观察

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目的 探讨腹腔持续冲洗引流治疗肠瘘合并腹腔感染的临床疗效及其应用价值。 方法 回顾性分析解放军兰州总医院普外科于 2012 年 3 月至 2017 年 3 月期间收治的 62 例行急诊手术的肠瘘合并腹腔感染患者的临床资料,所有患者行急诊手术后进行腹腔持续冲洗引流治疗。总结患者的持续腹腔冲洗时间、抗生素使用时间、血象恢复时间、瘘口愈合时间和总住院时间。 结果 62 例患者的手术救治均获成功,无死亡及感染性休克病例。术后出现腹腔脓肿 6 例,切口感染 5 例,胸腔积液 5 例,肺部感染 2 例,且患者均有不同程度的低蛋白血症。62 例患者的持续腹腔冲洗引流时间为(45±21)d,抗生素使用时间为(14±7)d,血象恢复时间为(16±8)d,瘘口愈合时间为(47±24)d,总住院时间为(56±27)d。其中 49 例肠瘘经持续腹腔冲洗引流治愈,13 例肠瘘经腹腔持续冲洗引流未治愈,行二期手术治愈。 结论 腹腔持续冲洗引流治疗肠瘘合并腹腔感染的疗效确切,治愈率较高,并发症少,冲洗设备简单,技术难度不高,经济实惠,冲洗设备护理方便,可为复杂性或难治性肠瘘患者再次手术创造良好的条件,有较高的临床应用价值。

Objective To explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection. Methods The clinical data of 62 patients with intestinal fistula combined with abdominal infection admitted by Department of General Surgery of Lanzhou General Hospital of PLA from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized. Results All 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d. Conclusion For intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.

关键词: 腹腔持续冲洗引流; 肠瘘; 腹腔感染

Key words: peritoneal continuous flushing and drainage; intestinal fistula; abdominal cavity infection

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