两针法连续缝合在回肠单腔造口术中的应用

A two-stitch continuous suture method for single-lumen ileostomy

目的探讨两针法连续缝合方式在回肠单腔造口术中应用的安全性及可行性。方法采用回顾性队列研究方法。回顾性分析2021年1月1日至2022年5月1日在南方医科大学珠江医院行预防性单腔回肠造口术的98例患者的临床资料。全组患者符合预防性回肠单腔造口术适应证,排除年龄>80岁、基础疾病复杂、全身条件极差不能耐受手术者、肠管末端血液供应不良以及肠管末端严重水肿或感染严重者。其中2021年10月1日前治疗的患者,采用传统的间断缝合法进行回肠造口(传统法造口组,60例);2021年10月1日以后治疗的患者,采用两针法连续缝合进行回肠造口(两针法造口组,38例)。两针法连续缝合回肠造口术操作如下:第1根缝线将肠管浆肌层与腹膜、后鞘及前鞘由深至浅分2层连续缝合;一期开放造口,第2根缝线将肠管全层与皮肤连续缝合。比较两组患者造口手术时间及术后造口相关并发症发生情况。结果两组患者基线资料比较,差异均无统计学意义(均P>0.05)。两针法造口组肠造口手术时间较传统法造口组短,差异有统计学意义[(16.6±2.2)min比(25.1±2.4)min,t=-17.874,P<0.001]。两针法造口组术后造口皮肤黏膜分离、造口周围皮炎和造口回缩的发生率低于传统法造口组[分别为5.3%(2/38)比31.7%(19/60),χ²=9.633,P=0.002;5.3%(2/38)比28.3%(17/60),χ²=7.923,P=0.005;2.6%(1/38)比18.3%(11/60),P=0.026],而造口旁疝、造口脱垂发生率及术后疼痛视觉模拟评分两组比较,差异无统计学意义(均P>0.05)。结论相比于传统单腔回肠造口术,两针法连续缝合回肠造口术具有手术时间短、操作简便的优势,还可减少造口相关并发症的发生。

Objective To explore the value of a two-stitch continuous suture in single-lumen ileostomy.Methods This was a retrospective cohort study.Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University.All patients met the indications for prophylactic single-lumen ileostomy.Those older than 80 years of age,with complex underlying diseases,extremely poor systemic conditions who could not tolerate surgery,poor blood supply at the end of the bowel,and severe edema or severe infection at the end of the bowel were excluded.Among the included patients,patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture(control group,n=60),and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy(two-stitch stoma group,n=38).Two-stitch continuous suture ileostomy is performed as follows:the first continuous suture is used to suture the intestinal seromuscular layer,peritoneum,posterior sheath,and anterior sheath from deep to superficial layers.The bowel wall is then opened.The second continuous suture is used to suture the full thickness of the bowel and the skin.The differences in postoperative ostomy-related complications and operation time were compared between the groups.Results There were no significant differences in baseline data between the groups(all,P>0.05).The operative time in the two-stitch stoma group was shorter than that of the control group(16.6±2.2 minutes vs.25.1±2.4 minutes,respectively;t=-17.874;P<0.001).The incidences of mucocutaneous separation,dermatitis,and stoma rebound in the two-stitch stoma group were lower than those of the control group[5.3%(2/38)vs.31.7%(19/60),χ2=9.633,P=0.002;5.3%(2/38)vs.28.3%(17/60),χ2=7.923,P=0.005;and 2.6%(1/38)vs.18.3%(11/60),P=0.026,respectively],while the incidences of parastomal hernia and stoma prolapse,and the postoperative visual analog scale scores in the two groups were similar(all P>0.05).Conclusion Compared with traditional single-lumen ileostomy,two-stitch continuous suture ileostomy has the advantages of short operation time,simplicity,esthetic appearance of the stoma,and a significant reduction in the postoperative complications associated with ileostomy.