CAJ | 학술논문

目的：探讨腹部腹腔镜手术后大块标本取出的切口并发症的影响因素。方法按设定标准回顾分析我科2006年6月～2012年6月腹腔镜肝脏、脾脏及胃肠道切除术后大块标本取出切口位置、长度、并发症及美容效果。结果符合入选标准301例，其中肝切除56例，脾切除43例，胃切除66例，右半结肠切除35例，横结肠切除12例，左半结肠切除9例，乙状结肠切除25例，直肠切除55例。切口位置：上腹正中切口125例，下腹正中切口50例，脐周绕脐切口61例， Pfannenstiel切口39例，左下腹斜切口13例，左中腹经腹直肌切口9例，陈旧性切口4例。切口感染11例（11/301，3．6％），切口疝2例（2/301，0．7％）。单因素和logistic回归分析结果显示：切口位置（β＝0．596， P＝0．000）和合并症（β＝-4．526，P＝0．000）是切口并发症的危险因素。结论腹部腹腔镜手术后大块标本取出的切口应兼顾消化道重建需要、肿瘤标本完整性、美容、微创及减少并发症等因素进行选择设计，切口位置和合并症是切口感染和切口疝的危险因素。
목적：탐토복부복강경수술후대괴표본취출적절구병발증적영향인소。방법안설정표준회고분석아과2006년6월～2012년6월복강경간장、비장급위장도절제술후대괴표본취출절구위치、장도、병발증급미용효과。결과부합입선표준301례，기중간절제56례，비절제43례，위절제66례，우반결장절제35례，횡결장절제12례，좌반결장절제9례，을상결장절제25례，직장절제55례。절구위치：상복정중절구125례，하복정중절구50례，제주요제절구61례， Pfannenstiel절구39례，좌하복사절구13례，좌중복경복직기절구9례，진구성절구4례。절구감염11례（11/301，3．6％），절구산2례（2/301，0．7％）。단인소화logistic회귀분석결과현시：절구위치（β＝0．596， P＝0．000）화합병증（β＝-4．526，P＝0．000）시절구병발증적위험인소。결론복부복강경수술후대괴표본취출적절구응겸고소화도중건수요、종류표본완정성、미용、미창급감소병발증등인소진행선택설계，절구위치화합병증시절구감염화절구산적위험인소。
Objective To study related factors on incisional complications for large specimen extraction after laparoscopic abdominal surgery. Methods From June 2006 to June 2012, incisions for large specimen extraction after laparoscopic abdominal surgery were studied retrospectively on location , length, complications, and cosmetic results. Results A total of 301 laparoscopic abdominal surgeries were retrieved , including 56 cases of liver resection ,43 cases of splenectomy , 66 cases of gastrectomy , 35 cases of right hemicolectomy , 12 cases of transverse colectomy , 9 cases of left hemicolectomy , 25 cases of sigmoidectomy , and 55 cases of proctectomy, respectively.According to the incision location , there were 125 cases of upper abdominal midline incisions , 50 cases of lower abdominal midline incisions , 61 cases of periumbilicus incisions , 39 cases of Pfannenstiel ’ s incisions, 13 cases of left lower quadrant oblique incisions ,9 cases of left lower quadrant transrectus incisions , and 4 cases of old incisions , respectively .Incisional infections were found in 11 patients (11/301, 3.6%) and incisional hernia was found in 2 patients(2/301, 0.7%).Univariate analysis and logistic regression analysis showed that different incision location (β=0.596, P =0.000 ) and co-morbidity (β=-4.526, P=0.000) were correlated to incisional complications . Conclusions Selection of incision for large specimen extraction after laparoscopic abdominal surgery should be based on reconstruction of digestive tract , maintenance of intact malignant specimen , cosmetic results,and performance of minimal invasive techniques .Location of incision and co-morbidity are risk factors for incisional complications .