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Ewentracja rany – na czym polega? Czynniki ryzyka

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Ewentracja, czyli całkowite rozejście się rany po operacji brzusznej, którego skutkiem jest wytrzewienie, to jedno z najpoważniejszych powikłań pooperacyjnych. Jakie są czynniki ryzyka ewentracji i jakie jej rodzaje można wyróżnić?

Czynniki ryzyka ewentracji rany

Wśród czynników ryzyka ewentracji rany można wskazać zarówno czynniki wewnętrzne, wynikające ze stanu zdrowia pacjenta, jak i czynniki zewnętrzne, związane z przebiegiem zabiegu operacyjnego. Do czynników wewnętrznych zalicza się:

– wiek powyżej 65 lat,

–  wystąpienie infekcji w łożysku rany,

– współistniejące choroby układu oddechowego (przewlekła obturacyjna choroba płuc, astma oskrzelowa, przewlekły kaszel),

– choroby nowotworowe,

– cukrzycę,

– zaburzenia krążenia,

– otyłość,

– palenie tytoniu,

– płeć męską,

– wyłonienie kolostomii lub ileostomii,

– długotrwałą terapię lekami steroidowymi.

Ryzyko zwiększa się także w sytuacji kiedy dojdzie do zakażenia miejsca operowanego lub wystąpienia martwicy w łożysku rany. Do zewnętrznych czynników ryzyka ewentracji należą natomiast:

– zastosowanie przez lekarza nieprawidłowej lub niedokładnej techniki szycia rany (nieprawidłowe zamknięcie powłok jamy brzusznej, niewłaściwy dobór materiału szewnego),

– zdjęcie szwów z rany zbyt wcześnie, zanim dojdzie do pełnego wygojenia,

– długi czas trwania operacji,

–znaczny stopień śródoperacyjnej kontaminacji,

– niedostateczna podaż płynów w ciągu pierwszej doby po zabiegu,

– okołooperacyjne przetoczenia krwi.

Ewentracja może również być skutkiem zastosowania przez lekarza nieprawidłowej lub niedokładnej techniki zszycia rany lub innego błędu medycznego (np. usunięcia szwów pooperacyjnych zbyt wcześnie).

Podział ewentracji

Wyróżnia się ewentracje podskórne oraz ewentracje całkowite. W przypadku ewentracji podskórnej ciągłość skóry zostaje zachowana, a rozejście obejmuje szew powięziowy. Ewentracja całkowita polega rozejściu się wszystkich warstw powłok brzusznych (skóra, powięź i jama otrzewna).

Leczenie ewentracji

Leczenie ewentracji odbywa się w warunkach operacyjnych i polega na ponownym chirurgicznym zespoleniu powłok brzusznych. Obarczone jest znacznym ryzykiem dalszych powikłań.

Źródło: W. Zimmer, T. Urbanek, D. Stańczyk, „Zamknięcie powłok jamy brzusznej – szew ciągły czy szwy pojedyncze?”, „Chirurgia Polska” 2008, 10, 1, 35-43.

Przeczytaj także: Pierwsza pomoc przy oparzeniach dróg oddechowych

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

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