负压十字缝合在回肠造口还纳术中的应用

Application of vacuum sealing drainage and gunsight closure in ileostomy reversal

目的探讨负压十字缝合技术用于回肠造口还纳术的可行性及优势。方法回顾性分析2017年5月至2021年3月重庆医科大学附属第二医院胃肠外科应用负压十字缝合技术行回肠造口还纳术的17例患者的临床资料。其中,直肠癌13例,均为低位直肠癌(7例为超低位直肠癌),家族性息肉2例,外伤2例。负压十字缝合操作方法:①沿菱形切口切缘常规完成造口游离皮瓣及吻合,皮下放置简易负压引流球。②取菱形各边的中点各缝1针,可吸收缝线环形缝合皮内各边缘,拉紧结扎时中心不留缝隙。③采用敷贴严密关闭切口,引流球保持负压。记录患者的手术参数及切口感染率。结果所有患者均顺利完成造口还纳,手术时间平均(100.7±56.6)min,术中出血量平均(20.0±22.9)mL。无一例发生术后感染。术后第1 d疼痛VAS评分为(0.9±1.2)分,术后住院时间(9.8±2.5)d,伤口愈合时间(9.0±2.4)d,住院总费用(24104.7±8524.7)元。失访1例,余16例于术后半年随访,切口美容满意度评分平均(9.1±1.0)分。结论采用负压十字缝合技术行回肠造口还纳术,切口感染风险低,愈合时间短,同时兼具操作简单、经济适用、美观的特点,值得推广和应用。

Objective To assess the clinical feasibility and value of vacuum sealing drainage and gunsight closure in ileostomy reversal.Methods A total of 17 patients underwent ileostomy reversal in our hospital from May 2017 to March 2021 were retrospectively analyzed,including 13 cases of low rectal cancer(of which,7 of ultra-low rectal carcinoma),2 cases of familial polyps and 2 cases of trauma.The procedure of vacuum sealing drainage and gunsight closure was as follows:①After stoma-centric symmetrical diamond incision made,the stoma was dissociated and anastomosed along the incision edge.Following peritoneum and anterior sheath intermittently sutured and closed,free skin flap below the incision was dissected and a simple negative pressure drainage ball was placed under the skin.②The mid-point on each side of the diamond incision was sutured once.The intradermal edges were circularly sutured with absorbable suture and ensured the center of each edge was symmetrical.Both ends of the suture were tightened for ligation without gap in the center.③The incision was covered tightly with small square plaster to preserve the negative pressure of the drainage ball.The surgical parameters of perioperation and the surgical site infection rate were recorded.Results All c ases accomplished the ileostomy reversal successfully.The average operative time was 100.7±56.6 min and the blood loss was 20.0±22.9 mL.There was no post-operative infection in all 17 cases.The pain score of VAS was 0.9±1.2 points,the postoperative hospital stay was 9.8±2.5 days,the wound healing time was 9.0±2.4 days,and the total cost of hospitalization was 24104.7±8524.7 yuan.One case was lost,and the other 16 cases scored 9.1±1.0 points in cosmetic satisfaction score of incision during half a year follow-up after the surgery.Conclusion The technique of vacuum sealing drainage and gunsight closure is a feasible closure method for ileostomy reversal with low surgical site infection risk,mild postoperative pain,short wound healing time and good aesthetics of incision.