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目的:探讨后腹腔镜术后穿刺孔延迟愈合的处理措施。方法:回顾性分析2003年1月～2008年12月行后腹腔镜肾脏及肾上腺手术患者689例的临床资料:术后发生穿刺孔延迟愈合25例,占3.63%。其中单纯伤口闭合不良12例,腹壁窦道形成8例,后腹腔皮肤瘘形成5例。运用湿性愈合方法处理单纯伤口闭合不良;使用带侧孔探针注生理盐水冲洗腹壁窦道;采用生理盐水特制棉签擦洗后腹腔皮肤瘘。清创期窦道伤口使用条状美盐(mesalt),每天换药1次,连续使用1～5天,伤口分泌物减少,过渡到肉芽增生期,窦道深度小于3cm,根据渗出物的多少选择藻酸盐类或水胶体糊剂填塞伤口,换药间隔3～5天。1例后腹腔皮肤瘘伴脓肿患者采用封闭式负压引流(VAC)辅助伤口愈合,4～6天换药1次。结果:5～10天,单纯闭合不良伤口愈合;10～15天,腹壁窦道伤口愈合;20～32天,后腹腔皮肤瘘伤口愈合。结论:湿性愈合适用于后腹腔镜术后穿刺孔延迟愈合,尤其是深腔和窦道感染伤口,是需要填补缺损的延期愈合伤口的标准非手术愈合方式。正确地评估伤口,并根据评估结果准确选择伤口敷料可缩短炎症期,缩短伤口愈合时间。美盐有利于坏死组织溶解与吸收,促进伤口清创,缩短炎症期过程,加速伤口愈合。
Objective: To explore the treatment measures of delayed puncture hole healing after laparoscopic surgery. Methods: The clinical data of 689 patients undergoing laparoscopic renal and adrenal surgery from January 2003 to December 2008 were retrospectively analyzed. 25 cases of delayed puncture healing occurred after operation, accounting for 3.63%. Among them, 12 cases were poor wound closure, 8 cases were abdominal sinus tract formation, and 5 cases had posterior abdominal cavity blemishes. Wet wound healing was used to treat poor wound closure; saline was used to rinse the abdominal sinus tract with a side hole probe; abdominal swabs were swabbed with a special cotton swab. The debridement sinus wounds use mesalt strips. They are changed once a day for 1 to 5 consecutive days. The wound secretions are reduced and the transition to granulation proliferative phase occurs. The depth of sinus tract is less than 3 cm, according to the exudates. How much choice of alginate or hydrocolloid paste filling wounds, dressing interval of 3 to 5 days. One patient with abdominal hernia accompanied by abscess treated with closed vacuum drainage (VAC) assisted in wound healing and changed dressing 4 to 6 days. Results: In 5 to 10 days, the wound was healed by simply closing the wound; in 10 to 15 days, the wound in the abdominal wall was healed; in 20 to 32 days, the wound in the abdominal cavity was healed. Conclusion: Wet-healing is suitable for the delayed healing of puncture holes after laparoscopic surgery, especially in deep cavity and sinus infection wounds. It is a standard non-surgical healing method for delayed healing of wounds that needs to be filled. Correctly assessing the wound and accurately selecting the wound dressing based on the assessment results in a shorter inflammatory phase and shorter wound healing time. Beautiful salt is conducive to the dissolution and absorption of necrotic tissue, promote wound debridement, shorten the process of inflammation, and accelerate wound healing.