持续负压引流配合间断冲洗对腹腔镜肛提肌外腹会阴联合切除术后手术部位感染的影响

Effect of continuous negative pressure drainage with intermittent irrigation on surgical site infection after laparoscopic extralevator abdominoperineal excison

目的探讨腹腔镜肛提肌外腹会阴联合直肠癌切除术（ELAPE）后骶前间隙持续负压引流配合间断冲洗对手术部位感染（SSI）的影响。 方法采用回顾性队列研究方法，纳入2016年3月至2017年8月间在山东省潍坊市人民医院接受腹腔镜ELAPE手术、且术后予以持续负压引流配合间断冲洗的28例患者（负压冲洗组）进行研究；同时收集2014年1月至2016年2月间接受腹腔镜ELAPE手术但术后采用传统自然引流的32例患者（自然引流组）作为对照。自制双套管的制作：取1根硅胶引流管，前端每隔1~2 cm剪3个侧孔，间断反向排列，并于中后段剪一小孔，经小孔放置输液器管至引流管前端侧孔处（此输液器的作用是，当引流液出现浑浊时，可外接生理盐水冲洗创腔）。自制双套管的放置和使用：将其置于骶前间隙，并从会阴部一侧坐骨结节内侧戳口引出，外接引流袋自然引流24 h，待引流管内无明显出血，接入负压引流球，并保持负压状态。比较两组患者术后30 d内SSI发生情况及其他围手术期指标。 结果两组患者基线资料的比较，差异均无统计学意义（均P 〉0.05）。负压冲洗组患者术后SSI发生率显著低于自然引流组[14.3%（4/28）比43.8%（14/32），χ2=6.173，P= 0.013），且术后住院时间亦明显缩短[（9.8 ± 1.5）d比（11.4 ± 2.6）d，t= 2.918，P= 0.005]；两组患者手术时间、术中出血量、引流管拔除时间等其他围手术期指标的差异均无统计学意义（均P 〉 0.05）。多因素分析证实，负压引流是ELAPE术后SSI发生的独立保护因素（OR=0.214，95%CI：0.060~0.762，P= 0.002）。 结论持续负压引流配合间断冲洗可有效降低腹腔镜ELAPE术后SSI发生率，且简单、安全。

ObjectiveTo explore the effect of continuous negative pressure drainage with intermittent irrigation on surgical site infection （SSI） after laparoscopic extralevator abdominoperineal excison （ELAPE） . MethodsClinical data of 28 rectal cancer patients who underwent continuous negative pressure drainage with intermittent irrigation following laparoscopic ELAPE （negative irrigation group） at our department from March 2016 to August 2017 were analyzed retrospectively. At the same time, 32 rectal cancer patients who underwent laparoscopic ELAPE and simple presacral drainage from January 2014 to February 2016 were included as controls （simple drainage group） . Self-made double cannula： one silicon rubber drainage tube was used; 3 side holes were cut at the front end with 1-2 cm interval; tube was ranked intermittently and oppositely; a small hole was cut in the middle of rear; the infusion tube was placed through the small hole to the front side of the drainage tube （to rinse when the drainage was turbid） . The placement and use of self-made double cannula： it was placed in the presacral space and was drawn from the medial to the sciatic tubercle, then was connected to drainage bag for 24 hours; when no blood was observed, the drainage tube was connected to negative pressure drainage ball, keeping negative pressure status. The development of SSI within 30 days postoperatively and other perioperative parameters were compared between the two groups. ResultsThere were no statistically significant differences in baseline data between two groups （all P 〉 0.05） . Incidence of SSI in negative irrigation group was significantly lower than that in simple drainage group [14.3% （4/28） vs. 43.8% （14/32） , χ2=6.173, P= 0.013]. Additionally, a shorter postoperative hospital stay was observed in negative irrigation group [ （9.8±1.5） days vs. （11.4±2.6） days, t= 2.918, P= 0.005]. Besides, other perioperative parameters, including operative time, intraoperative blood loss, time to removal of drainage tube, etc were not significantly different between two groups （all P 〉 0.05） . After adjusting to confounders, multivariate analysis showed that negative pressure drainage was an independent protective factor for SSI following laparoscopic ELAPE （OR= 0.214, 95%CI： 0.060-0.762, P= 0.002） . ConclusionContinuous negative pressure drainage with intermittent irrigation can effectively decrease the incidence of SSI following laparoscopic ELAPE, and is safe and simple.