乙状结肠造口引流对低位直肠癌ELAPE术后切口感染的影响分析

Effect of sigmoidostomy and drainage on incision infection after ELAPE for low rectal cancer

目的探讨乙状结肠造口引流对肛提肌外腹会阴联合切除术(ELAPE)治疗低位直肠癌患者术后切口感染的影响。方法回顾性分析2015年1月至2018年1月本院收治的采用ELAPE术式治疗的62例低位直肠癌患者临床资料,按术后引流方案划分为对照组(n=28)和观察组(n=34)。对照组在会阴切口处放置2根骶前引流管,进行负压引流及骶前灌洗;观察组在对照组基础上,在乙状结肠造口处放置蕈状引流管。对比两组患者院内恢复效果、会阴切口及腹部切口愈合情况及感染相关并发症发生情况。结果观察组术后住院时间短于对照组,差异有统计学意义(P <0.05)。观察组腹部切口愈合时间短于对照组,愈合效果好于对照组,差异均有统计学意义(均P <0.05)。两组患者会阴切口愈合时间及愈合效果对比,差异均无统计学意义(均P> 0.05)。观察组造口切口感染、粪水性皮炎发生率低于对照组,差异均有统计学意义(均P <0.05)。结论在会阴切口引流的基础上,对乙状结肠造口进行早期引流有助于促进低位直肠癌ELAPE术后患者腹部切口的愈合,降低手术部位感染发生风险。

Objectives To investigate the effect of sigmoidostomy and drainage on incision infection after extralevator abdominoperineal excision(ELAPE)for low rectal cancer.Methods This was a retrospective analysis of clinical data of 62 patients with low rectal cancer treated with ELAPE in our hospital between January 2015 and January 2018.Based on the postoperative drainage methods,patients were divided into treatment group(n=28)and control group(n=34).For the patients in the control group,two presacral drainage tubes were placed near perineal incision,and negative pressure drainage and presacral lavage were performed.For those in the treatment group,additional sigmoidostomy was performed and‘mushroom’drainage tubes were placed at the stoma.Recovery,perineal and abdominal wound healing and complications related to infection were compared between the two groups.Results Duration of postoperative hospitalization and time to abdominal wound healing were significantly shorter,and quality of wound healing significantly better in the treatment group than in control group(P<0.05).Time to perineal wound healing and quality of wound healing did not differ between the two groups(P>0.05).Stoma incision infection and fecal dermatitis occurred significantly less in the treatment group than in the control group(P<0.05).Conclusion Early sigmoidostomy and drainage in additional to perineal incision drainage can effectively promote abdominal wound healing and reduce incision infection in patients with low rectal cancer after ELAPE.