CAJ | 학술논문

目的慢性伤口长期反复感染增加处理难度和癌变风险.文中旨在探讨慢性伤口癌变筛查方法、临床特征及干预方法,为临床及早发现和有效干预提供依据. 方法入选2010 年1 月至2014 年8 月在南京军区南京总医院初诊为慢性伤口患者共358 例,分为手术治疗组(n =78)和非手术治疗组(n =280),2 组均包扎伤口使用银敷料抗感染,全身采用口入营养食谱、心理调适等整体干预方案,前者实施病灶切除和转皮瓣手术,2 组干预观察期均为从伤口处理开始至第9 周.观察指标包括癌变检出率、致病菌阳性率、癌变伤口愈合率等. 结果 358 例患者癌变检出率为6.70%,癌变伤口患者的持续时间中位数为352.50d,癌变伤口类型构成比分别为不典型伤口(58.33%)、切口难愈(25%)、压疮(8.33%)、静脉性溃疡(4.17%)、外伤溃疡(4.17%).致病菌阳性率67.32%,2 组患者干预期内无死亡,伤口总愈合率差异无统计学意义(P =0.187),但手术治疗组癌变伤口愈合率高于非手术治疗组(75.00% vs 37.50%, P =0.040). 结论长期感染是诱发慢性伤口癌变的可能原因,手术治疗是癌变伤口和引流不畅深部伤口的有效干预手段,非手术治疗是癌变伤口姑息治疗的可选方法和大部分未癌变伤口的有效干预方法.
목적 만성상구장기반복감염증가처리난도화암변풍험.문중지재탐토만성상구암변사사방법、림상특정급간예방법,위림상급조발현화유효간예제공의거. 방법 입선2010 년1 월지2014 년8 월재남경군구남경총의원초진위만성상구환자공358 례,분위수술치료조(n =78)화비수술치료조(n =280),2 조균포찰상구사용은부료항감염,전신채용구입영양식보、심리조괄등정체간예방안,전자실시병조절제화전피판수술,2 조간예관찰기균위종상구처리개시지제9 주.관찰지표포괄암변검출솔、치병균양성솔、암변상구유합솔등. 결과 358 례환자암변검출솔위6.70%,암변상구환자적지속시간중위수위352.50d,암변상구류형구성비분별위불전형상구(58.33%)、절구난유(25%)、압창(8.33%)、정맥성궤양(4.17%)、외상궤양(4.17%).치병균양성솔67.32%,2 조환자간예기내무사망,상구총유합솔차이무통계학의의(P =0.187),단수술치료조암변상구유합솔고우비수술치료조(75.00% vs 37.50%, P =0.040). 결론 장기감염시유발만성상구암변적가능원인,수술치료시암변상구화인류불창심부상구적유효간예수단,비수술치료시암변상구고식치료적가선방법화대부분미암변상구적유효간예방법.
Objective Long-term repeated infection of chronic wounds adds to the difficulty of management and risk of can -cerization.This article aimed to investigate the malignancy screening , clinical characteristics , and intervention strategies of chronic wounds in order to provide some evidence for the early detection and effective intervention of cancerization . Methods We allocated 358 patients with chronic wounds to a surgical (n=78) a non-surgical treatment group (n=280), both treated by application of silver dressing, oral nutrition and psychological adjustment , the former by lesion resection and skin flap transplantation in addition , both for 9 weeks.We analyzed the rates of cancerization, pathogenic bacteria, and wound healing using the software SPSS16.0. Results Among the 358 cases, cancerized wounds accounted for 6.70%, including atypical wound (58.33), difficult healing (25%), pres-sure sore (8.33), venous ulcer (4.17), and trauma ulcer (4.17), lasting for a median of 352.50 days.No death occurred during the intervention .The healing rate of the malignant wounds was markedly higher in the surgical than in the non -surgical treatment group (75%vs 37.50%, P=0.040), but there were no statistically significant differences in the total healing rate between the two groups (P=0.187). Conclusion Long-term infection may be a cause of cancerization of chronic wounds .Surgical treatment is an effective in-tervention strategy for malignant wounds and benign wounds with ten -don or bones exposure , while non-surgical treatment can be used as a palliative care method for malignant wounds and an effective interven-tion for most benign wounds .