115例腹会阴直肠切除术会阴伤口一期缝合的评估

Evaluation of 115 Cases of Primary Closure of Perineal Wound Following Abdominoperineal Excision

本文就115例腹会阴直肠切除术,对会阴伤口的两种不同处理方法进行分析比较.在年龄、性别、病理分期及恶性程度无明显差异的情况下,会阴伤口一期缝合组的平均愈合时间为16.90±4.35天,伤口敞开组为37.04±15.44天,差异显著(P<0.002).术后局部复发率分别为3/69例和2/46例,均为4.35%(P>0.05).一期缝合组的平均住院费用约为敞开组的46.87%～76.52%.作者指出,鉴于直肠癌逆行向下的淋巴扩散极为罕见,仅发生于高恶性或伴广泛淋巴转移的病例,因而对癌肿远端需切除2cm～3cm正常肠管而同时切除肛直肠环、不得不作手术者,会阴部清除范围无需太大,会阴伤口可分层完全缝合;对位于肛管内或侵及肛直肠环的癌肿,须彻底清除坐骨直肠窝脂肪结缔组织.本文两组术后局部复发率无差异,进一步表明这一认识的正确性.本组结果充分表明了会阴伤口一期缝合法的合理性与可行性.

This paper presents an analysis and comparison between two different methods of perineal wound management following abdominoperineal excision. The two groups were comparable in terms of age, sex, staging and grade. The perineal wound healing time was significantly shorter in the primary closure group (16.90±4.35 days) than in the open wound group (37.04±15.44 days), (P< 0.002). Local recurrence rates were 3/69 (4.35%) and 2/46 (4.35%) respectively (P>0.05). The cost of hospitalization of the primary closure was only 46.87% - 76.52% of that of the open wound group. The authors stress that the distal spread in rectal cancer is rare and occurs only in cases of high malignancy or wide - spread lymphnode involvement. In such cases, extended dissection of the ischiorectal fossa should be carried out, and the resulting spacious dead space is to be openly drained, while in other cases when an uninvolved ano-rectal ring has to be sacrificed due to the location of the tumor, the dissection should be much less in extent, and primary perineal closure could be performed without undue tension. The shorter hospital stay, lesser hospitalization cost and no increased local recurrence rate indicate, when properly selected, the primary closure of perineal wound following A-P excision is rational and feasible.