改进菱形切口在回肠造口关瘘术中的应用  

The Clinical Value of Newly Diamond Incision in Stoma Closure

作　　者：袁园园 刘刚磊[1] 王沙龙[1] 袁联文[1] YUAN Yuan-yuan;LIU Gang-lei;WANG Sha-long;YUAN Lian-wen(Department of Geratic Surgery,Second Xiangya Hospital,Central South Universit)

机构地区：[1]中南大学湘雅二医院老年外科,长沙410011

出　　处：《中国现代手术学杂志》2017年第4期261-264,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的改进回肠造口关瘘术切口的设计,观察菱形切口在回肠关瘘术中的临床应用价值。方法回顾2016年12月~2017年3月我科应用菱形切口行5例肠关瘘术患者的临床资料。经过原造瘘口圆心,垂直于腹部皮纹距离原造瘘口边缘1 cm的上下两点为A、C,平行于皮纹贴近原造瘘口边缘的两点为B、D,连接四点形成菱形ABCD,长对角线为4~5 cm,短对角线为2~3 cm;取AB、BC、CD、AD四条边的中点皮下依次进针,拉拢收紧使切口成十字,中间保留绿豆大小孔隙利于皮下引流。结果本组5例患者肠关瘘手术时间平均90(65~115)min。术后伤口疼痛轻微,无切口疝及感染发生,疤痕愈合满意。结论菱形切口关闭造瘘口操作简便,可降低术后感染,减少术后疼痛,并且外观美容效果好,较传统梭形切口有一定的优势。Objective To improve the design of operative incision in stoma closure and to further evaluate the value of newly diamond incision. Methods The clinical data of 5 cases performed stoma closure from December 2016 to March 2017 were analyzed retrospectively. Taking two points,marked as A or C,which are about 1 centimeter distant from the edge of the fistula. The line AC was perpendicular to the abdominal dermatoglyphs,and pass through the center of original fistula. Another two points,marked as B or D,were closed to the edge of the fistula. The line BD was paralleled to dermatoglyphs. Connecting four points into a diamond-ABCD with the long diagonal of 4 to 5 centimeters and short diagonal of 2 to 3 centimeters. Join the mid-points on each side of the diamond-ABCD by a needle,then,tighten the cut into a cross,indwelling gram size pore in the middle against the subcutaneous drainage. Results The operative time of stoma closure was 65 to 115 minutes with an average of 90 minutes in all 5 cases. No serious post-operative complications such as severe pain,incisional hernia and superficial incisional surgical site infection（SSI） were found. Conclusion The diamond incision can be superior to the conventional fusiform incision with simple operating,lower SSI,less pain and better cosmetic result.

关 键 词：菱形切口 关瘘术 回肠造口术 感染 

分 类 号：R735.3[医药卫生—肿瘤]