会阴部切口改良和大网膜填充骶前空腔预防腹会阴联合手术切口并发症的效果

THE EFFECT OF MODIFIED METHOD OF PERINEAL INCISION AND GREATER OMENTUM FILLED TO THE PRESACRAL SPACE ON THE PREVENTION OF PERINEAL COMPLICATIONS AT MILES OPERATION

目的回顾性分析腹会阴联合手术(Miles)中会阴切口改良和大网膜填充方法对会阴部切口并发症的作用,探讨减少会阴部切口并发症的方法。方法 84例直肠癌患者分为常规Miles手术治疗组(n=28,Miles组)、会阴部切口改良和大网膜填充骶前空腔组(n=56,改良组),对两组围手术期会阴部切口并发症及伤口引流量进行分析和比较。结果Miles组切口感染5例,切口皮下脂肪坏死3例,切口裂开3例,伤口愈合时间(21.3±4.5)d,住院时间(31.4±7.2)d,切口引流量第1、2、3、4天分别为(432.8±38.2)、(217.4±28.8)、(83.5±17.3)和(51.2±15.9)ml。改良组切口感染3例,切口皮下脂肪坏死2例,切口裂开1例,伤口愈合时间(16.8±2.7)d,住院时间(21.9±3.3)d;切口引流量第1、2、3、4天分别为(386.3±27.5)、(131.6±19.1)、(33.8±12.6)和(18.2±10.7)ml。两组之间各种并发症和每天引流量之间均有显著性差异(p<0.05)。结论会阴部切口改良和大网膜填充骶前空腔的方法在Miles手术中对减少会阴部切口并发症有良好作用,值得推广应用。

Objective Retrospective analysis of the effect of modified method of perineal incision and greater omentum filled to the presacral space on the prevention of perineal complications at Miles operation. Methods Analyzed the perineal complications of postoperation of patients with rectal cancer that had been treated with Miles operation. The patients had been divided into two groups, the Miles operation group （ n = 28 ） and the modified perineal incision method and greater omenhum filled to the presacral space at Mi- les operation group （ n = 56 ）. Compare and analyze the complication occurred at perineal incision in peri - operation period and the drainage volume of the 1,2,3,4 day between the two groups. Results There were five infection of incisional wound, three subcutane- ous fat necrosis, three disruption of wound in Miles operation group, and the average wound healing time was 21.3 ±4.5 days, the average length of stay was （ 31.4 ± 7.2 ） days, the draining volume was （432.8 ± 38.2） , （217.4 ± 28.8 ） , （ 83.5 ± 17.3 ） , （ 51. 2 ± 15.9） ml at the first, second, third, forth day after operation, respectively. There were three infection of incisional wound, two subcutaneous fat necrosis, one disruption of wound in modified perineal incision operation group, and the average wound healing time was （16.8 ±2.7） days, the average length of stay was （21.9 ±3.3） days, the draining volume was （386.3 ± 27.5） , （ 131.6 ± 19.1 ）, （ 33.8 ± 12.6 ）, （ 18.2 ± 10.7 ） ml at the first, second, third, forth day after operation, respectively. There were significant difference about the complications of perineal incision and draining volume between two groups. Conclusion The modified method of perineal incision and greater omentum filled to the presacral space was better to reduce the complications of perineal incision at Miles ooeration.