十字缝合较直线缝合可显著减少回肠造口还纳术的手术部位感染

Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures

背景:手术部位感染(SSI)是回肠造口还纳术后最常见的并发症之一。尽管一些皮肤闭合技术被提出以减少SSI发生率,但何种技术最优仍不明确。本研究比较了两种回肠造口还纳术后两种切口缝合技术(十字缝合与直线缝合)对SSI的影响。方法:2015年1月至2017年12月间在中山大学附属第六医院进行回肠襻式造口的223例患者被纳入研究。根据造口还纳时的切口缝合方式,患者被分为直线缝合组(130例)和十字缝合组(103例)。比较两组患者临床病理特征,并分析SSI的危险因素。结果:两组患者均顺利完成手术。术后SSI发生率十字缝合组显著低于直线缝合组(2%vs 12%,P=0.007)。十字缝合组术后住院时间较直线缝合组显著缩短(8.1˘3.2 vs 10.8˘5.4天,P<0.001)。多因素分析证实,十字缝合是术后SSI的独立保护因素(OR=0.212,P=0.048)。结论:与直线缝合技术相比,十字缝合可显著降低SSI发生率并缩短术后住院时间。我们推荐将十字缝合用于回肠造口还纳手术的切口关闭。

Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal procedure remains unclear.In this study,we compared the effect of two surgical techniques for wound closure following ileostomy reversal:gunsight suture(GS)and linear suture(LS).Methods:A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study.These patients were divided into two groups:the LS group and the GS group.We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI.Results:Both groups successfully underwent surgery.The rate of SSI was significantly lower in the GS group(n=2,0.02%)than in the LS group(n=16,12.00%,P=0.007).The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group(8.163.2 vs 10.865.4 days,P<0.001).Multivariate analysis showed that GS was an independent protective risk factor for SSI(odds ratio=0.212,P=0.048).Conclusions:Compared with the LS technique,the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery.The GS technique may be recommended for wound closure following ileostomy reversal.