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由于淋巴结多汇聚于颈部,因此是多种恶性肿瘤的好发部位。颈部甲状腺癌发病率从30岁开始上升,在40~60岁到达发病的高峰,60岁后又开始下降[1]。目前最有效的治疗方法仍然是手术根治术,但是手术根除颈部巨大甲状腺癌往往会遗留颈部皮肤大面积的创面形成,术后的创面修复也是肿瘤外科的一个重要课题,20世纪90年代开始,随着移植技术的发展,各种部位的游离组织皮瓣开始应用于临床,颈部巨大甲状腺癌术后的修复有了很大的发展,逐步代替了之前多年使用的蒂转移组织皮瓣的治疗方法[2]。但是由于在皮瓣的修复过程需要较高的操作技巧要求,费用昂贵,不能排除自身转移等术后复发的可能性,因此在颈部巨大甲状腺癌术后创面修复中很难预测其预后效果[3]。采用负压封闭引流技术(VSD)可以根据病人个体化设计方案大大提高了创面的修复效果,可以应用于各式各样的创面修复,且存活率高,治疗效果明显[4]。本研究纳入了我院2014年1月至2016年11月确诊为颈部巨大甲状腺癌并行肿瘤根治手术治疗的89例病人,并在手术过程中应用VSD取得良好效果,现作报道。
颈部巨大甲状腺癌术后负压封闭引流技术疗效分析
The postoperative application value of the vacuum sealing drainage technique in patients with giant malignant thyroid
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摘要:
目的探讨应用负压封闭引流技术(VSD)对颈部巨大甲状腺癌切除术后创面修复效果的影响。 方法选择确诊为颈部巨大甲状腺癌并行肿瘤根治手术治疗的病人89例,随机分为2组,其中对照组44例,给予根治手术后直接行游离组织皮瓣治疗;观察组45例,根治术后应用VSD覆盖创面,术后给予持续负压引流72 h,压力为6.65~7.98 mmHg,72 h后给予间歇性负压引流治疗,根据术后创面恢复的情况,术后1~2周停止负压引流,并根据肉芽组织的生长情况给予创面的植皮治疗。比较2组病人的创面修复情况。 结果观察组有39例病人于术后2周内停止了创面的VSD,创面肉芽组织存活良好,完全覆盖了颈部的重要组织和血管,没有脓液分泌,及时进行了创面植皮,植皮后皮肤愈合良好,另外6例于术后2周肉芽组织生长情况欠佳,经过1~2次清创、再次负压引流后,肉芽组织生长良好,顺利进行了植皮术。对照组有13例病人出现伤口感染,经反复换药伤口最终愈合,但遗留明显瘢痕,7例病人出现了移植皮瓣坏死,需再次行清创、皮瓣移植。2组间伤口感染率差异有统计学意义(χ2=15.57,P < 0.01);观察组皮肤愈合时间(3.57±1.83)周,显著低于对照组的(6.75±2.42)周(t=7.00,P < 0.01)。 结论颈部巨大甲状腺癌切除术后应用VSD技术具有操作简单、减少感染概率、促进创面愈合、病人耐受度高等优点,是巨大甲状腺癌术后组织缺损修复中的安全有效的方法。 Abstract:ObjectiveTo explore the application effects of vacuum sealing drainage (VSD) technique on wound healing of cervical giant thyroid carcinoma after operation. MethodsEighty-nine cervical giant thyroid carcinoma patients treated with radical surgery were randomly divided into the control group(n=44) and observation group(n=45).The control group was treated with radical tissue flap, and the observation group was treated with radical tissue flap combined with VSD covering wound.After operation, the observation group was continously drainaged under the pressure of 6.65 to 7.98 mmHg for 72 h, then intermittently drainaged.After 1 to 2 weeks of operation, the VSD was stopped according to the postoperative wound recovery, and the wound was treated with skin graft according to the growth of granulation tissue.The wound repair between two groups was compared. ResultsThe VSD in 39 cases of observation group was stopped after 2 weeks of operation, the wound granulation tissue survival was good, completely covered the important organization and blood vessels of neck, and no pus secretion was found.The wound was timely grafted with skin, and the skin healing was good.The granulation tissue growth in 6 cases was poor in observation group after 2 weeks of operation, the wound was treated with debridement for 1 for 2 times and VSD, the skin graft surgery was successfully implemented after granulation tissue growth was good.Thirteen cases with wound infection in control group were found, the wound healed after repeated dressing wounds, and the obvious scars were identified.The skin flap necrosis in 7 cases were identified in control group, and the debridement and flap transplantation should be performed again.The difference of the infection rate of wound between two groups was statistically significant(P < 0.01).The average healing time of skin in observation group[(3.57±1.83) weeks] was significantly lower than that in control group[(6.75±2.42) weeks] (t=7.00, P < 0.01). ConclusionsThe application of VSD technique after resection of giant thyroid carcinoma can reduce the probability of infection, promote the wound healing, and improve the tolerance of patients.It is a simple, safe and effective method for repairing postoperative tissue defect of giant thyroid carcinoma. -
Key words:
- thyroid neoplasms /
- vacuum sealing drainage /
- flap repair /
- wound treatment
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