皮下引流持续冲洗负压吸引术在肠造口还纳术后预防切口感染的前瞻性研究

doi:10.3877/cma.j.issn.1674-0793.2020.02.012

目的

探讨皮下引流持续冲洗负压吸引术在结直肠癌手术并肠造口患者行还纳术后预防切口感染的应用价值。

方法

前瞻性选择2017年2月至2018年12月佛山市第一人民医院收治的100例肠造口患者，按照随机数字表法分成两组，在肠造口还纳术中关闭切口时采用不同措施，每组50例，试验组采用皮下引流持续冲洗负压吸引装置，对照组采用传统关闭切口方法。比较两组患者的围手术期资料以及术后切口感染率。

结果

两组患者均采取开腹手术，无一例围手术期死亡。两组造口类型、初次造口时机、造口时间、手术时间、术中出血量比较，差异均无统计学意义。试验组患者术后住院时间为（7.0±5.7）d，术后切口感染率为2.0%（1/50），显著低于对照组的（9.5±5.6）d、16.0%（8/50），差异有统计学意义（t=-2.193，P=0.031；χ²=4.396，P=0.036）。

结论

皮下引流持续冲洗负压吸引术能有效降低结直肠癌肠造口还纳术患者的切口感染发生率，缩短住院时间，临床应用价值较高。

关键词: 肠造口术, 负压伤口疗法, 引流术, 伤口感染

Objective

To explore the application value of subcutaneous drainage tube with continuous irrigation and vacuum suction after enterostomy to reduce surgical site infection.

Methods

One hundred patients with enterostomy from February 2017 to December 2018 were randomized into two groups with different wound closure techniques in stoma reversal, with 50 cases in each group. Patients in the trial group were placed subcutaneous drainage tube with continuous irrigation and vacuum suction when the skin was closed. Patients in the control group were assigned to undergo conventional skin closure. The terms of perioperative clinical data and surgical site infection rates were recorded and analyzed.

Results

All patients in the two groups underwent laparotomy, and none of them died during the perioperative period. There were no significant differences between the groups in terms of stoma type, stoma indication, stoma reversal duration, operative time, and blood loss. The hospitalization time was (7.0±5.7) d and the incidence of incision infection was 2.0% (1/50) in the trial group, which were significantly lower than (9.5±5.6) d and 16.0% (8/50) in the control group, the differences were statistically significant (t=-2.193, P=0.031; χ²=4.396, P=0.036).

Conclusion

The subcutaneous drainage tube with continuous irrigation and vacuum suction after stoma reversal can gain high application value, effectively reducing surgical site infection rates and hospital stay in patients with stoma after colorectal cancer operation.

Key words: Enterostomy, Negative-pressure wound therapy, Drainage, Wound infection

图1 负压引流管的制作

图2 回肠造口还纳时负压引流管的使用

图3 结肠造口还纳时负压引流管的使用

表1 100例患者肠造口还纳术前一般资料比较

组别	例数	性别(例)		年龄(岁)^a	体质指数(kg/m²) ^a	合并疾病(例)				新辅助放化疗(例)
组别	例数	男	女	年龄(岁)^a	体质指数(kg/m²) ^a	糖尿病	高血压	心脏疾病	肺部疾病	新辅助放化疗(例)
试验组	50	32	18	60.2±14.7	24.1±3.8	7	9	4	3	34
对照组	50	30	20	62.8±12.7	22.9±3.4	7	6	3	4	31
统计值	?	0.170		-0.964	1.691	0.367				0.396
P值	?	0.680		0.338	0.094	0.545				0.529
组别	血红蛋白水平(g/L)^a	白蛋白水平(g/L) ^a	ASA分级(例)			AJCC TNM分期(例)
组别	血红蛋白水平(g/L)^a	白蛋白水平(g/L) ^a	Ⅰ	Ⅱ	Ⅲ	T2N1~2	T3N0-2	T4N0-2
试验组	128.1±19.4	40.8±4.7	9	31	10	10	27	13
对照组	125.0±14.7	39.8±3.4	11	30	9	9	29	12
统计值	0.899	1.193	0.269			0.164
P值	0.371	0.236	0.874			0.921

表1 100例患者肠造口还纳术前一般资料比较

组别	例数	性别(例)		年龄(岁)^a	体质指数(kg/m²) ^a	合并疾病(例)				新辅助放化疗(例)
组别	例数	男	女	年龄(岁)^a	体质指数(kg/m²) ^a	糖尿病	高血压	心脏疾病	肺部疾病	新辅助放化疗(例)
试验组	50	32	18	60.2±14.7	24.1±3.8	7	9	4	3	34
对照组	50	30	20	62.8±12.7	22.9±3.4	7	6	3	4	31
统计值	?	0.170		-0.964	1.691	0.367				0.396
P值	?	0.680		0.338	0.094	0.545				0.529
组别	血红蛋白水平(g/L)^a	白蛋白水平(g/L) ^a	ASA分级(例)			AJCC TNM分期(例)
组别	血红蛋白水平(g/L)^a	白蛋白水平(g/L) ^a	Ⅰ	Ⅱ	Ⅲ	T2N1~2	T3N0-2	T4N0-2
试验组	128.1±19.4	40.8±4.7	9	31	10	10	27	13
对照组	125.0±14.7	39.8±3.4	11	30	9	9	29	12
统计值	0.899	1.193	0.269			0.164
P值	0.371	0.236	0.874			0.921

表2 100例肠造口还纳患者术中和术后情况比较

组别	例数	造口类型(例)		初次造口时机(例)		造口时间(d) ^a	手术时间(min)^a	术中出血量(ml)^a	住院时间(d) ^a	术后切口感染(例)
组别	例数	回肠	结肠	急诊	择期	造口时间(d) ^a	手术时间(min)^a	术中出血量(ml)^a	住院时间(d) ^a	术后切口感染(例)
试验组	50	22	28	21	29	186.2±49.4	146.1±50.1	83.2±64.5	7.0±5.7	1
对照组	50	25	25	19	31	181.7±55.1	141.7±53.9	80.8±72.1	9.5±5.6	8
统计值	?	0.361		0.167		0.426	0.422	0.174	-2.193	4.396
P值	?	0.548		0.683		0.671	0.674	0.862	0.031	0.036

表2 100例肠造口还纳患者术中和术后情况比较

组别	例数	造口类型(例)		初次造口时机(例)		造口时间(d) ^a	手术时间(min)^a	术中出血量(ml)^a	住院时间(d) ^a	术后切口感染(例)
组别	例数	回肠	结肠	急诊	择期	造口时间(d) ^a	手术时间(min)^a	术中出血量(ml)^a	住院时间(d) ^a	术后切口感染(例)
试验组	50	22	28	21	29	186.2±49.4	146.1±50.1	83.2±64.5	7.0±5.7	1
对照组	50	25	25	19	31	181.7±55.1	141.7±53.9	80.8±72.1	9.5±5.6	8
统计值	?	0.361		0.167		0.426	0.422	0.174	-2.193	4.396
P值	?	0.548		0.683		0.671	0.674	0.862	0.031	0.036

[1]	柯梦，喻学桥，江从庆, 等. 国内结肠造口术和回肠袢式造口术对老年乙状结肠癌、直肠癌的临床疗效的Meta分析[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(1): 42-49.
[2]	Zhou P, Hrabe J, Byrn J. A retrospective, single-institution review of loop ileostomy reversal outcomes[J]. Ostomy Wound Manage, 2016, 62(8): 22-33.
[3]	Hsieh MC, Kuo LT, Chi CC, et al. Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate: A Meta-analysis of randomized controlled trials[J]. Dis Colon Rectum, 2015, 58(8): 808-815.
[4]	Zhen ZJ, Lai EC, Lee QH, et al. Conventional wound management versus a closed suction irrigation method for infected laparotomy wound--A comparative study[J]. Int J Surg, 2011, 9(5): 378-381.
[5]	Todd B. New CDC Guideline for the prevention of surgical site infection[J]. Am J Nurs, 2017, 117(8): 17.
[6]	郁宝铭. 低位直肠癌外科治疗的回顾、现状与展望[J]. 中华普通外科杂志, 2002, 7(7): 389-391.
[7]	Mrak K, Uranitsch S, Pedross F, et al. Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial[J]. Surgery, 2016, 159(4): 1129-1139.
[8]	Snijders HS, van den Broek CB, Wouters MW, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go?[J]. Eur J Surg Oncol, 2013, 39(7): 715-720.
[9]	Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative complications after protective ileostomy closure delay: An institutional study[J]. World J Gastrointest Surg, 2014, 6(9): 169-174.
[10]	Dusch N, Goranova D, Herrle F, et al. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture[J]. Colorectal Dis, 2013, 15(8): 1033-1040.
[11]	Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, et al. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection[J]. Dis Colon Rectum, 2013, 56(2): 205-211.
[12]	Pan HD, Wang L, Peng YF, et al. Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy[J]. Int J Colorectal Dis, 2015, 30(7): 977-982.
[13]	Cantero R, Rubio-Perez I, Leon M, et al. Negative-pressure therapy to reduce the risk of wound infection following diverting loop ileostomy reversal: An initial study[J]. Adv Skin Wound Care, 2016, 29(3): 114-118.
[14]	李清汉，甄作均，吴志鹏, 等. 皮下引流管持续冲洗及负压吸引预防腹部Ⅳ类切口感染的前瞻性研究[J]. 中华消化外科杂志, 2015, 14(10): 839-843.
[15]	Kaiser AM, Israelit S, Klaristenfeld D, et al. Morbidity of ostomy takedown[J]. J Gastrointest Surg, 2008, 12(3): 437-441.
[16]	Geng HZ, Nasier D, Liu B, et al. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma[J]. Ann R Coll Surg Engl, 2015, 97(7): 494-501.
[17]	Hu WH, Lee KC, Tsai KL, et al. Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes[J]. Int J Colorectal Dis, 2018, 33(1): 47-52.

[1]	翟延荣, 朱亚萍, 张秀珍, 钟晓娟, 鲁香月, 张雨凡, 陆树良. 比较新型硅橡胶负压冲洗引流系统与聚氨酯负压引流系统体外防堵塞性能的观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(02): 116-122.
[2]	王铄链, 刘毅, 胡智瀚. 负压伤口疗法的作用、机制及其在糖尿病足临床治疗中的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(01): 69-72.
[3]	徐庆连. 下肢严重车祸伤创面修复的经验、教训[J]. 中华损伤与修复杂志(电子版), 2023, 18(01): 92-92.
[4]	蓝青楠, 俞金龙, 余捷, 何首华, 翁起宁, 罗桂芝, 邹琦, 邹兆伟. 改良两针法连续缝合在回肠单腔造口术中的应用[J]. 中华普通外科学文献(电子版), 2023, 17(04): 278-281.
[5]	鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[6]	贺亮, 王松林, 周业江. 两种预防性回肠造口在腹腔镜ISR术治疗超低位直肠癌的效果对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 697-700.
[7]	毛永欢, 仝瀚文, 缪骥, 王行舟, 沈晓菲, 喻春钊. 造口旁疝危险因素预测模型构建[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 682-687.
[8]	肖泽林, 高健齐, 刘家杰, 曾定科. 负压封闭引流术治疗胸壁结核的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 397-399.
[9]	刘虎, 崔昭扬, 乐羿, 杨豪, 张绍庚. 胰十二指肠切除术后胰管支架管致肝脓肿一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 444-448.
[10]	李子寒, 濮天, 陈江明, 郭旗, 蒋东, 陈子祥, 刘付宝. 复发性肝内胆管结石患者术后T管延迟拔除影响因素预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 206-210.
[11]	武帅, 吴含雪, 莫建涛, 杨沛泽, 程亚丽, 仵正. 术前胆道引流对壶腹周围癌患者术后并发症和远期生存的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 82-86.
[12]	夏文豪, 吴作友, 张飞鸿, 黄平. 腹会阴联合直肠切除术后结肠造口癌一例[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 342-347.
[13]	李翠园, 刘骞. 回肠造口旁腹壁伤口裂开一例并文献复习[J]. 中华结直肠疾病电子杂志, 2023, 12(01): 79-84.
[14]	王宏宇, 李刚, 李宏宇. 双侧慢性硬膜下血肿术后并发大面积脑梗死1例报道并文献复习[J]. 中华神经创伤外科电子杂志, 2023, 09(01): 58-61.
[15]	运陌, 李茂芳, 王浩, 刘东远. 微创穿刺引流联合吡拉西坦、乌拉地尔治疗基底节区高血压性脑出血的临床研究[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 278-285.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Subcutaneous drainage tube with continuous irrigation and vacuum suction after enterostomy toreduce surgical site infection: A prospective study

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Subcutaneous drainage tube with continuous irrigation and vacuum suction after enterostomy toreduce surgical site infection: A prospective study