骶前引流联合皮下负压引流在腹腔镜经腹会阴联合切除术的应用研究  

Application research of presacral space drainage tube combined with subcutaneous vacuum pressure suction in the laparoscopic-assisted abdominoperineal resection

作　　者：陈黎奇[1] 曾长青[1] 池良杰 黄良祥[1] 李建党[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院胃肠外科,福州350001

出　　处：《中华胃肠外科杂志》2017年第8期919-922,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨腹腔镜经腹会阴联合切除术后会阴部切口的处理措施。 方法 回顾性分析2009年6月至2014年2月期间在福建省立医院胃肠外科行腹腔镜辅助经腹会阴直肠癌切除术治疗的87例低位直肠癌患者的临床资料。其中42例采用骶前引流（骶前引流组），45例采用骶前引流联合皮下负压引流（联合引流组）。联合皮下组除放置骶前引流管外，于皮下置引流管一根接负压球，经会阴部切口侧前方另戳孔引出固定。皮下负压引流管置管2周、色清亮且连续3 d量少于15 ml，同时B超未见明显盆腔积液，且切口无红肿、水肿、愈合可，即予拔除。结果 全组男51例，女36例，年龄26~78（56.9 ± 10.8）岁。所有病例均顺利完成手术，无一例死亡，无严重并发症发生。骶前引流组放置骶前引流管4~13（8.0 ± 2.5）d；联合皮下组放置骶前引流管4~14（6.7 ± 2.4）d，皮下负压引流管放置14~24（15.8 ± 3.0）d。骶前引流组的一期愈合率为66.7%（28/42），联合皮下组的一期愈合率为91.1%（41/45），差异有统计学意义（χ2= 7.911，P= 0.005）。骶前引流组切口感染率为21.4%（9/42），联合皮下组切口感染率4.4%（2/45），差异有统计学意义（χ2= 5.674，P=0.017）。结论 腹腔镜经腹会阴联合切除术后会阴切口一期缝合采用骶前引流联合皮下负压引流对切口愈合的疗效好，值得临床推广应用。Objective To study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer. Methods Clinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group： presacral space drainage tube was applied in 42 patients. Combined drainage group： presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and 〈 15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed.Results There were 51 males and 36 females with the mean age of 26-78 （56.9 ± 10.8） years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13 （8.0 ± 2.5） days in presacral space drainage group, and for 4-14 （6.7 ± 2.4） days in combined drainage group. The subcutaneous tube was placed for 14-24 （15.8 ± 3.0） days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7% （28/42） and 91.1% （41/45） respectively, while the perineal wound infection rate was 21.4% （9/42） and 4.4% （2/45） respectively, whose differences between two groups were both significant （χ2= 7.911, P= 0.005 and χ2= 5.674, P= 0.017） .Conclusion Presacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has bet

关 键 词：直肠肿瘤 腹腔镜 经腹会阴联合切除 会阴部切口感染 

分 类 号：R735.37[医药卫生—肿瘤]