帝王切開後の腹腔内感染に対しピンポイント型創内持続陰圧洗浄療法を用いた1例

A Use of Pinpoint Closed Intra-Wound Continuous Negative Pressure and Irrigation: Treatment for an Intra-abdominal Infection after Caesarean Section

はじめに

　これまでわれわれは，創内持続陰圧洗浄療法（intra-wound continuous negative pressure and irrigation treatment：以下，IW-CONPIT）を用いて，さまざまな感染創の早期治癒を可能としてきた 1）～8）。今回われわれは，一期的閉鎖をせざるを得ない腹腔内感染創の症例に対して，閉鎖創におけるIW-CONPITを改良したピンポイント型創内持続陰圧洗浄療法（pinpoint closed intra-wound continuous negative pressure and irrigation treatment：以下，PPIW）を用い，創治癒を得ることができたので，本症例およびPPIWの有用性について報告する。なお，PPIWは本学倫理委員会で承認された。

　We have been using intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) for several years to achieve the early healing of all infected wounds. For infected wounds that must be closed, we have devised a pinpoint closed intra-wound continuous negative pressure and irrigation (PPIW) treatment that allows the pinpoint cleaning of the area to be cleaned. We describe the use of this treatment for an intra-abdominal infection after a Caesarean section. The patient was a 25-year-old woman who had undergone her second cesarean section at another hospital. On the 16th postoperative day, she was referred to our Obstetrics and Gynecology Department and our department for examination. Imaging studies revealed wound dehiscence at the uterine suture site and an intra-abdominal abscess; an open debridement and re-stitching of the uterus were therefore performed. During the suturing, contamination and infection were observed from the retroperitoneum to the Douglas fossa, and the patient thus underwent PPIW treatment in our department. She then underwent daily washing for the first 5 postoperative days, and she healed with no infection.