游离腹膜腔伤口引流的局部效应和变化。

R Ernst, C Wiemer, E Rembs, J Friemann, A Theile, K Schäfer, V Zumtobel
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引用次数: 15

摘要

在一项前瞻性随机研究中,30只杂种兔接受了两次标准的结肠切除。测试了三种类型的引流管:(乳胶-橡胶-)彭罗斯引流管、橡胶管引流管和硅管引流管,它们被放置在下腹部。作为一个封闭的排水系统,排水管的腹膜外尖端被放置在一个封闭的皮下口袋。两个结肠吻合口中的一个也被抽干了。于术后第7天记录结果。他们发现了一个单一的机械变化,一个由硅管挤压腹壁引起的溃疡。机械性刺激的其他迹象是显微镜下不明的异物引流的炎症反应。未见引流引起的上行感染。所有感染均来自结肠切除术的并发症。与通常的观点相反,下腹部的排水管没有与腹壁或器官粘连。在几乎所有病例中,只有引流管进入腹膜的入口和彭罗斯引流管的棉花凝视显示粘连。吻合口引流管的大量粘连是由结肠吻合口并发症引起的。由于材料的原因,橡胶和乳胶橡胶排水管表面显示出大量的纤维蛋白凝块。术后7天,只有约20%的引流管功能正常。其余部分则被引流管或棉眼内的纤维蛋白凝块堵塞。总的来说,三种不同类型的排水管在变化和效果上没有区别,但硅作为材料显示出优势。
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[Local effects and changes in wound drainage in the free peritoneal cavity].

In a prospective randomised study 30 mongrel rabbits received two standard colon-resections. Three types of drains were tested: (latex-rubber-) Penrose-drains, rubbertube- and silicontube-drains, which were placed in the lower abdomen. As a closed drainage-system the extraperitoneal tip of the drain was placed in a closed subcutis-pocket. One of the two colon-anastomoses also was drained. The findings were recorded on the 7th postoperative day. A single mechanic alteration was found, an ulcer caused by a silicon-drain, that pushed against the abdominal wall. The other signs of mechanic irritation were microscopically unspecified inflammatory reactions to the foreign body drain. There was no ascending infection caused by the drain. All infections came from complications of the colon resections. In contrast to common opinions the drains in the lower abdomen showed no adhesions to the abdominal wall or organs. Only the entrance of the drain into the peritoneum and the cotton-gaze of Penrose-drains showed in nearly all cases adhesions. The large amount of adhesions to the anastomosis-drains came from complications of the colon-anastomoses. As a cause of material, rubber- and latex-rubber-drains showed large fibrin-clots on their surfaces. 7 days after the operation only about 20% of the drains had sufficient function. The rest was occluded by fibrin-clots in the lumen of the drain or the cotton-gaze. Over all there is no difference in changes and effects of the three different types of drains, but silicon as material showed advantages.

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