蘑菇头引流管在乙状结肠造口术后的应用

Application of mushroom drainage heads after low rectal sigmoid colostomy

目的中低位直肠癌乙状结肠造口术后人工肛门置入粗蘑菇头引流管荷包,直接开放协助结肠排气排便,探讨其减少切口感染、腹胀等相关并发症的应用。方法采集武警指挥学院医院2004年10月至2012年1月中低位直肠癌行乙状结肠造口术患者60例临床资料。将研究对象随机分为二组,每组各30例,试验组(蘑菇头组)于乙状结肠造口即人工肛门置入蘑菇头荷包并通过引流袋直接开放,术后约5d拆开荷包,拔除蘑菇头引流管。对照组(一期开放组)乙状结肠造口直接开放。对二组患者的造瘘口、手术切口感染、造口周围粪水性皮炎、腹胀发生率、肠道功能恢复时间、进流食时间等进行比较。结果试验组30例患者中出现造口本身切口感染1例,腹部手术切口感染1例,切口周围粪水性皮炎2例,腹胀3例,肠道功能恢复时间为术后(16±4.5)h,术后进流食时间(18±3.5)h。对照组30例患者,其中造口切口感染6例,腹部手术切口感染5例,造口周围粪水性皮炎11例,腹胀2例,肠道功能恢复时间为术后(14±5.5)h,术后进流食时间(17±4.7)h。二组间数据比较,造口切口感染、腹部手术切口感染、造口周围粪水性皮炎差异均有统计学意义(χ2=4.0310、9.4118、7.9542,P均<0.05);腹胀、肠道功能恢复时间、术后进流食时间差异均无统计学意义(χ2=0.0000,t=1.5415、0.9347,P均>0.05)。结论蘑菇头引流管荷包法协助乙状结肠造口排气、排液,既可以预防和减少术后造口切口、腹部手术切口感染、造口周围粪水性皮炎,又能协助早期排气、排液,减少腹胀出现,有利于肠道功能早期恢复,早期进食。不但工作量小,且并发症少,值得进一步推广。

Objective To explore the implantation of mushroom head drainage tubes to assist the colon exhaust defecation and avoid incision infection, bloating and other complications after low rectal sigmoid colostomy. Methods A total of 60 patients with rectal neoplasms were operated with low rectal sigmoid co- lostomy from October 2004 to January 2012 in Clinic of Forced Police Command School. The subjects were randomly classified into two groups （ 30 patients for each group）. In the test group （ mushroom head group）, the mushroom head pockets were placed with open drainage bags by sigmoid colostomy. The drainage bag was released after 5 days and tubes were removed. In the control group （ open group）, the colostomy was open. The surgical wound, infection, peristomal fecal dermatitis, incidence of bloating, recovery time of intestinal function, and time of liquid feeding between two groups were compared. Results One case of wound infection,one case of abdominal infection,2 cases of dermatiffs,3 cases of bloating in the 30 patients of test group were observed. The recovery time of intestinal function after operation was （ 16 ± 4. 5 ） hours. The time of feeding after operation was （ 18 ± 3.5 ） hours. In the 30 patients of control group ,6 cases of wound infections, 5 cases of abdominal surgical infections, 11 cases of dermatitis, and 2 cases of bloating were included. The recovery time of intestinal function after operation was （ 14± 5.5 ） hours. The time of feeding after operation was （17 ±4.7） hours. There were significant differences in wound infecffon,abdominal infection and dermatiffs between the two groups （ X2 = 4.031 0,9.411 8,7. 954 2, all P 〈 0.05 ） ; and no difference was found within the groups in terms of bloating, the recovery time of intestinal function, the time of feeding after operation （ X2 = 0.000 0, t = 1. 541 5,0.934 7, all P 〉 0.05 ）. Conclusions The mushroom drainage heads assisted the colostomy for exhaustion, drainage and avoid bloating, wound infection, dermatitis, which could be recommended in clinical practice due to the advantages for recovery time of intestinal function and food intakes with lower workloads and fewer complications.