中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2015年
7期
656-660
,共5页
潘宏达%王林%彭亦凡%顾晋
潘宏達%王林%彭亦凡%顧晉
반굉체%왕림%팽역범%고진
直肠肿瘤%回肠造口%还纳术%并发症%切口感染%危险因素
直腸腫瘤%迴腸造口%還納術%併髮癥%切口感染%危險因素
직장종류%회장조구%환납술%병발증%절구감염%위험인소
Rectal neoplasms%Ileostomy%closure technique%Complication%Surgical site infection%Risk facor
目的：观察直肠癌低位前切除保护性回肠造口还纳术后并发症发生情况,并探讨术后切口感染的危险因素。方法回顾性分析2006年9月至2013年3月间于北京肿瘤医院接受保护性回肠造口还纳术的245例低位直肠癌患者的临床病理资料。观察患者术后相关并发症的发生情况,并对可能影响术后切口感染的临床病理特征进行单因素和多因素分析。结果造口还纳术后有33例(13.5%)患者出现了并发症,其中手术切口感染21例(8.6%),肠梗阻8例(3.3%),吻合口瘘或直肠阴道瘘5例(2.0%),肺部感染2例(0.8%,其中1例合并败血症),肛门括约肌功能障碍2例(0.8%)。全组无围手术期死亡病例,但有5例(2.0%)患者接受了二次手术治疗,包括肠梗阻3例及直肠阴道瘘和吻合口瘘各1例。术后并发症(OR=10.576,95%CI：2.898~38.597, P=0.000)及手术时间大于90 min(OR=4.862,95%CI：1.758~13.451, P=0.002)是切口感染的独立危险因素﹔而皮下引流(OR=0.063,95%CI：0.007~0.540, P=0.012)是切口感染的独立保护因素。结论切口感染是保护性回肠造口还纳术后最为常见的并发症。皮下负压引流是降低切口感染率的有效手段﹔对于手术时间超过90 min的患者,推荐行皮下负压引流。
目的：觀察直腸癌低位前切除保護性迴腸造口還納術後併髮癥髮生情況,併探討術後切口感染的危險因素。方法迴顧性分析2006年9月至2013年3月間于北京腫瘤醫院接受保護性迴腸造口還納術的245例低位直腸癌患者的臨床病理資料。觀察患者術後相關併髮癥的髮生情況,併對可能影響術後切口感染的臨床病理特徵進行單因素和多因素分析。結果造口還納術後有33例(13.5%)患者齣現瞭併髮癥,其中手術切口感染21例(8.6%),腸梗阻8例(3.3%),吻閤口瘺或直腸陰道瘺5例(2.0%),肺部感染2例(0.8%,其中1例閤併敗血癥),肛門括約肌功能障礙2例(0.8%)。全組無圍手術期死亡病例,但有5例(2.0%)患者接受瞭二次手術治療,包括腸梗阻3例及直腸陰道瘺和吻閤口瘺各1例。術後併髮癥(OR=10.576,95%CI：2.898~38.597, P=0.000)及手術時間大于90 min(OR=4.862,95%CI：1.758~13.451, P=0.002)是切口感染的獨立危險因素﹔而皮下引流(OR=0.063,95%CI：0.007~0.540, P=0.012)是切口感染的獨立保護因素。結論切口感染是保護性迴腸造口還納術後最為常見的併髮癥。皮下負壓引流是降低切口感染率的有效手段﹔對于手術時間超過90 min的患者,推薦行皮下負壓引流。
목적：관찰직장암저위전절제보호성회장조구환납술후병발증발생정황,병탐토술후절구감염적위험인소。방법회고성분석2006년9월지2013년3월간우북경종류의원접수보호성회장조구환납술적245례저위직장암환자적림상병리자료。관찰환자술후상관병발증적발생정황,병대가능영향술후절구감염적림상병리특정진행단인소화다인소분석。결과조구환납술후유33례(13.5%)환자출현료병발증,기중수술절구감염21례(8.6%),장경조8례(3.3%),문합구루혹직장음도루5례(2.0%),폐부감염2례(0.8%,기중1례합병패혈증),항문괄약기공능장애2례(0.8%)。전조무위수술기사망병례,단유5례(2.0%)환자접수료이차수술치료,포괄장경조3례급직장음도루화문합구루각1례。술후병발증(OR=10.576,95%CI：2.898~38.597, P=0.000)급수술시간대우90 min(OR=4.862,95%CI：1.758~13.451, P=0.002)시절구감염적독립위험인소﹔이피하인류(OR=0.063,95%CI：0.007~0.540, P=0.012)시절구감염적독립보호인소。결론절구감염시보호성회장조구환납술후최위상견적병발증。피하부압인류시강저절구감염솔적유효수단﹔대우수술시간초과90 min적환자,추천행피하부압인류。
Objective To analyze the complications of ileostomy closure and related risk factors. Methods Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital from September 2006 to March 2013 were included in this study. Clinical features of these patients were reviewed, the complications rate was calculated, and univariate and multivariate analyses with regard to the risk factors of surgical site infection (SSI) were also conducted. Results A total of 245 consecutive patients were enrolled in the study. Thirty-nine complications were observed in thirty-three patients, the overall complication rate was 13.5%. Complication after primary closure of defunctioning ileostomy included surgical site infection (n=21, 8.6%), ileus (n=8, 3.3%), preoperatively undiagnosed anastomotic leakage or rectovaginal fistula(n=5, 2.0%), pulmonary infection (n=2, 0.8%), and anal sphincter dysfunction (n=2, 0.8%). No patient died in the perioperative period, and 5 patients (2.0%) underwent reoperation for ileus (n=3), anastomotic leakage (n=1) andrectovaginal fistula (n=1). Multivariate analysis showed that postoperative complications [OR=10.576, 95%CI:2.898-38.597, P=0.000] and total operation time >90 min [OR=4.862, 95% CI:1.758-13.451, P=0.002] were independent risk factors of SSI, and the presence of subcutaneous vacuum drainage [OR=0.063, 95%CI:0.007-0.540, P=0.012] was protective factor of SSI. Conclusions Surgical site infection is the most common complication after primary closure of defunctioning ileostomy. Subcutaneous vacuum drainage is effective for reducing SSI in patients undergoing primary closure of ileostomy, and it is especially recommended for patients with operation time >90 min.
