腹会阴直肠切除术会阴伤口一期缝合的评估

Evaluation of primary closure of perineal wound following abdominoperineal excision

对115例腹会阴直肠切除术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，差异有显著性意义（P＜0．002）。术后局部复发率均为4．35％（P＞0.05）。认为对癌肿远端需切除2～3cm正常肠管而同时切除肛直肠环、不得不作Miles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。

This paper presents an analysis and comparision between two different methods of perineal wound management following abdominoperineal excision. The 2 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 rate were 3/69 (4. 35 % ) and 2 /46 (4. 35 % ) respectively (P>0.05 ). 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 where 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.