Jakie mogą wystąpić miejscowe wczesne powikłania pooperacyjne?
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Jakie mogą wystąpić miejscowe wczesne powikłania pooperacyjne?

Ten tekst przeczytasz w 2 min.

Wśród miejscowych wczesnych powikłań pooperacyjnych wymienić należy zbiornik płynu surowiczego w ranie, krwiak w ranie pooperacyjnej, zakażenie rany, rozejście się rany pooperacyjnej czy wytrzewienie.

Powikłanie w postaci zbiorniku płynu surowiczego w ranie należy nakłuć i odessać lub założyć dren Redona, z ewentualnym stałym odsysaniem i opatrunkiem uciskowym. Odessany płyn wysyła się na badanie bakteriologiczne.

Kolejnym wczesnym powikłaniem pooperacyjnym jest krwiak w ranie pooperacyjnej, którzy tworzy się w wyniku zaburzeń krzepnięcia krwi, niedostatecznej hemostazy, przyjmowania niesteroidowych leków przeciwzapalnych, nadciśnieniem bądź napinaniem okolicy rany. Powstały krwiak należy opróżnić, poprzez nakłucie lub niewielkie rozwarcie brzegów rany. W przypadku narastania krwiaka, ranę należy kontrolować. Ważne jest również odnalezienie i zaopatrzenie krwawiącego naczynia.

Powikłaniem pooperacyjnym będzie również zakażenie rany, które kwalifikuje się jako najczęstsze zakażenie szpitalne. Pacjent wówczas odczuwa ból, rana jest obrzęknięta, zaczerwieniona, towarzyszy jej wyciek treści ropnej oraz gorączka.

Rana może również ulec rozejściu się. Do tego powikłania dochodzi zazwyczaj przez nieodpowiednią technikę operacyjną, krwiaka zropienia rany, a także długotrwałe stosowanie sterydów przed operacją. Niewątpliwie dodatkowo przyczyniają się do tego takie czynniki, jak kaszel, wymioty, niedożywienie, hipoalbuminemia, wzdęcia, cukrzyca, jak również zbyt wczesne usunięcie szwów.

Ponadto, miejscowym wczesnym powikłaniem pooperacyjnym będzie również wytrzewienie, czyli rozejście się rany w jamie brzusznej na całej jej głębokości. W efekcie tego dochodzi do odsłonięcia czy wypadnięcia trzewi na powłoki. Na wystąpienie tego powikłania mają wpływ również takie czynniki, jak otyłość, hipoalbuminemia, niedożywienie, długotrwałe stosowanie sterydów, krwiak lub zakażenie w ranie oraz nadciśnienie w jamie brzusznej. Przy wytrzewieniu pojawia się obfity wyciek treści surowiczej, ropnej bądź krwistej. Wówczas niezbędne będzie założenie szwów przez wszystkie warstwy powłoki brzusznej.

Źródło: Noszczyk W., Chirurgia Repetytorium, Wydanie II uaktualnione Warszawa 2019, s. 62-63

Przeczytaj także: Case study: leczenie ZSC po amputacji palca. Uwaga: ZDJĘCIA!

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