CAJ | 학술논문

目的对比研究经腹会阴联合直肠切除术(Miles术)后骶前腔隙的自然引流或持续灌洗对会阴切口愈合的影响.方法对2004年10月至2009年8月实施Miles术的74例患者进行前瞻性研究,术后3 d将患者随机分为骶前持续灌洗组和骶前自然引流组,观察比较两组患者会阴部切口感染、积液、延迟愈合等情况.将会阴切口愈合情况分为甲级、乙级和丙级愈合三种.结果共74例患者纳入本研究.随机入组持续灌洗组37例(含术前放疗12例),入组自然引流组37例(含术前放疗10例).持续灌洗组会阴切口出现丙级愈合2例,乙级愈合3例,甲级愈合32例;自然引流组则分别为8例,3例,26例;两组间丙级愈合率差异有统计学意义(5.4%比21.6%,P=0.042).本研究中行术前放疗者22例,3例会阴切口丙级愈合,4例乙级愈合,15例甲级愈合;直接手术患者52例,7例会阴切口丙级愈合,2例乙级愈合,43例甲级愈合,两组间乙级愈合率差异有统计学意义(18.2%比3.9%,P=0.039).结论持续骶前灌洗明显改善经腹会阴联合直肠切除术后会阴切口的愈合情况,术前50 Gy的长程放疗可明显提高会阴切口乙级愈合的比例.
목적 대비연구경복회음연합직장절제술(Miles술)후저전강극적자연인류혹지속관세대회음절구유합적영향.방법 대2004년10월지2009년8월실시Miles술적74례환자진행전첨성연구,술후3 d장환자수궤분위저전지속관세조화저전자연인류조,관찰비교량조환자회음부절구감염、적액、연지유합등정황.장회음절구유합정황분위갑급、을급화병급유합삼충.결과 공74례환자납입본연구.수궤입조지속관세조37례(함술전방료12례),입조자연인류조37례(함술전방료10례).지속관세조회음절구출현병급유합2례,을급유합3례,갑급유합32례;자연인류조칙분별위8례,3례,26례;량조간병급유합솔차이유통계학의의(5.4%비21.6%,P=0.042).본연구중행술전방료자22례,3례회음절구병급유합,4례을급유합,15례갑급유합;직접수술환자52례,7례회음절구병급유합,2례을급유합,43례갑급유합,량조간을급유합솔차이유통계학의의(18.2%비3.9%,P=0.039).결론 지속저전관세명현개선경복회음연합직장절제술후회음절구적유합정황,술전50 Gy적장정방료가명현제고회음절구을급유합적비례.
Objective To compare the effects of presacral irrigation and simple drainage on the perineal wound healing in patients after abdominoperineal resection (APR). Methods From October 2004 to August 2009, patients with rectal cancer, ulcerative colitis or rectal gastrointestinal stromal tumor, who underwent APR or proctocolectomy, were randomized into two arms: simple drainage group (n = 37 ) and continuous irrigation (n =31). Patients randomized to arm B received simple drainage only to presacral space; while those patients in arm A received continuous irrigation in addition to simple drainage. Perineal wound healing was taken as endpoint of this study. Major complication was defined as wound dehiscence or wound infection that the perineal wound should be reopened for drainage. Minor complication was defined as delayed healing wound with seroma or hematoma. Results A total of 74 patients were enrolled in present study, with 37 patients in each arm, and there were 12 cases and 10 cases who received preoperative radiation therapy, respectively. In the arm A, 2 patients developed major complications, 3 patients incurred with minor complications and 32 patients got primary healing of the perineal wounds. In arm B, 8 patients suffered major complications, 3 patients incurred with minor complications and 26 patients got primary healing of the perineal wounds. The incidence of major complication was significantly lower in arm A (5.4% vs. 21.6% , P = 0.042). Patients received preoperative radiation therapy had significantly higher rate of minor complications than patients underwent surgery only (18.2% vs. 3.9% , P = 0. 039 ). Conclusions Simple drainage with continuous irrigation of the presacral space, in patients with abdominalperineal resection or proctocolectomy, could significantly lower the incidence of major complication and improve wound healing for perineal wound when compared with simple drainage only. Preoperative radiation therapy tends to increase the incidence of minor complications.