探讨湿性疗法在肝病患者术后切口愈合不良中的应用价值。

回顾性分析2011年1月至2014年1月在中山大学附属第三医院行手术治疗的54例术后切口愈合不良患者临床资料。其中男45例，女9例；年龄24～70岁，中位年龄47岁；均合并肝病。所有患者均签署知情同意书，符合医学伦理学规定。对愈合不良的切口按照湿性疗法换药，对患者进行局部及整体评估，根据评估结果选择合适的清洗液，根据切口基底组织的活性、位置及患者的凝血功能选择机械性清创、保守锐性清创、自溶性清创，通过渗液管理、密闭伤口来营造有利于伤口愈合的微环境，选择适宜的磺胺嘧啶银脂质水胶体敷料、高渗盐敷料、藻酸钙敷料、亲水性纤维敷料、亲水性纤维银离子敷料等包扎固定伤口。了解导致患者切口愈合不良的原因，观察湿性疗法处理后切口愈合情况。

导致切口愈合不良的原因包括皮下脂肪液化30例、切口感染16例、皮下血肿8例。54例患者切口经湿性疗法处理5～21 d后肉芽生长良好，其中42例行二期手术缝合，12例行3M免缝胶带加压拉合，切口均完全愈合，治愈率达100%。

对术后切口愈合不良肝病患者采用湿性疗法换药，能有效促进切口肉芽组织生长，为二期愈合提供有利条件。

To explore the value of moist therapy for delayed wound healing in patients with liver diseases after surgery.

Clinical data of 54 patients undergoing surgical treatments with delayed wound healing in the Third Affiliated Hospital of Sun Yat-sen University from January 2011 to January 2014 were analyzed retrospectively. There were 45 males and 9 females with the age ranging from 24 to 70 years old and a median of 47 years old. All the patients were complicated with liver diseases. The informed consents of all patients were obtained and the ethical committee approval was received. Moist therapy was used in the dressing changing of the delayed healing wounds. After regional and overall assessment, appropriate cleaning solutions were chosen. According to the activity of wound basal lamina, location and patients' coagulation function, mechanical debridement, conservative sharp debridement or autolytic debridement were chosen. Microenvironment which benefited the wound healing was created through exudates management and wound sealing. Different wound dressings such as silver sulphadiazine impregnated hydrocolloid dressing (Urgotul SSD), sodium chloride impregnated dressing (Mesalt), calcium alginate dressing (Sorbalgon), hydrofiber dressing (Aquacel), silver-containing hydrofiber dressing (Aquacel Ag) were chosen and the wounds were dressed and fixed. The causes of delayed wound healing were explored and the wound healing were observed after giving moist therapy.

The causes of delayed wound healing included subcutaneous fat liquefaction (n=30), incision infection (n=16), subcutaneous hemotoma (n=8). After giving moist therapy for 5 to 21 d, the granulation proliferation of the wounds was observed well in 54 patients. Forty-two cases received second suture and the wounds in 12 cases were compressed and pulled up using 3M steri-strip. All the wounds healed completely with a cure rate of 100%.

Moist therapy can promote the proliferation of granulation tissues of patients with liver diseases and delayed wound healing after surgery, and provides favorable condition for the secondary healing.