改良荷包缝合技术在双腔造口还纳术中的应用研究

Application of modified purse-string closure in the wound following loop stoma reversal

目的探讨改良荷包缝合技术对比直接缝合技术在双腔造口还纳术中缝合皮肤过程中的安全性和可行性。方法回顾性分析2011年7月至2013年6月期间,在首都医科大学附属北京朝阳医院普通外科接受双腔造口还纳手术的88例患者的临床资料,其中改良荷包缝合技术43例(改良荷包缝合组),直接缝合45例(直接缝合组)。改良荷包缝合组操作方式为:(1)可吸收线环周缝合皮下脂肪组织,打结时避免打紧,保留中央1cm孔隙;(2)可吸收线荷包缝合真皮层,打结时保留中央0.5cm孔隙;(3)孔隙内留置橡皮引流线。记录并比较两组患者的临床参数、手术结果和术后并发症发生情况。结果全组患者男性56例,女性32例,年龄(65.0±11.5)岁,恶性肿瘤79例,良性肿瘤6例,外伤3例;改良荷包缝合组与直接缝合组基线资料的比较差异均无统计学意义(均P>0.05)。与直接缝合组比较,改良荷包缝合组术后伤口感染率低[7.0%(3/43)比24.4%(11/45),χ^2=5.015,P=0.025];术后住院时间短(平均数:7.1d比8.6d,t=-2.656,P=0.010);住院总花费低(平均数:25668.4元比27718.1元,t=-2.488,P=0.015);但改良荷包缝合组的伤口愈合时间显著延长(平均数:22.0d比13.0d,t=5.701,P<0.001)。直接缝合组中伤口感染病例的伤口平均愈合时间为29.8d,显著长于一期愈合病例的7.5d(t=-15.446,P<0.001);改良荷包缝合组中感染病例的伤口平均愈合时间为22.0d,与一期愈合病例的22.1d比较,差异无统计学意义(t=0.077,P=0.943)。结论改良荷包缝合技术是一种适宜的造口还纳后皮肤缝合技术,可以显著降低造口还纳后的伤口感染率,缩短住院时间,降低住院花费,但总体伤口愈合时间较长。

Objective To compare the safety and feasibility between modified circumferential purse-string closure and conventional primary linear closure of the wound following loop stoma reversal. Methods Clinical data of 88 consecutive patients who underwent loop colostomy or loop ileostomy closures at our hospital from July 2011 to June 2013 were retrospectively analyzed.Among them,43 cases underwent modified purse-string technique (modified purse-string group),45 cases underwent direct suture (direct suture group).The operation method of modified purse-string suture was as follows: (1)the circumferential subcutaneous adipose tissue was sutured with the absorbable suture,avoiding tightening at knotting and retaining a 1 cm pore;(2)absorbable suture was used to perform purse-string suture of the dermis,retaining a 0.5 cm central pore when knotting;(3)a rubber drain was placed through the pore.The clinical parameters,surgical results and postoperative complication of two groups were recorded and compared.Results There were 56males and 32females with age of (65.0± 11.5)years old.Seventy-nine cases were malignant tumors,6 were benign tumors and 3 were traumatic. There was no significant difference in the baseline data between two groups (all P>0.05).Compared with the direct suture group,the modified purse-string group had significantly lower wound infection rate [7.0%(3/43)vs.24.4%(11/45),χ^2=5.015,P=0.025];significantly shorter postoperative hospital stay (mean 7.1 days vs.8.6days,t=-2.656,P=0.010);significantly lower total hospitalization costs (mean 25668.4 yuan vs.27718.1 yuan,t=-2.488,P=0.015);however,the wound healing time of the modified purse-string group was significantly longer (mean 22.0 days vs.13.0 days,t=5.701, P<0.001).The average healing time of the wounds in the direct suture group was 29.8 days,which was significantly longer than that of the first-stage healing cases (7.5 days,t=-15.446,P<0.001).The average wound healing time of the infected cases in the modified purse-string suture group was 22.0 days, compared with 22.1 days in the first-stage healing cases,the difference was not statistically significant (t =0.077,P =0.943).Conclusions Modified purse-string closure after loop stoma reversal is an appropriate technique with lower stoma site infection rate,shorter postoperative hospital stay and lower hospitalization cost than conventional primary closure,although wounds may take longer to heal in this approach.