Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

创新封闭伤口负压引流技术在肠造口黏膜旁感染伤口护理中的应用效果

目的:探讨创新封闭伤口负压引流技术在肠造口黏膜旁感染伤口治疗中的应用效果。方法:采用便利抽样法选取2020年2月—2022年10月吉林大学第三临床医院收治的直肠癌术后肠造口黏膜旁伤口感染患者100例,按随机数表法将其分为对照组和观察组,各50例。对照组采取正常换药方法对造口黏膜旁感染伤口进行护理,观察组采取创新封闭伤口负压引流技术对造口黏膜旁感染伤口进行护理。比较两组患者换药次数和底盘更换次数、伤口愈合时间、治疗费用及患者满意度。结果:观察组换药次数、底盘更换次数分别为(2.19±0.80)次、(2.30±0.50)次,少于对照组的(5.40±1.41)次、(5.33±2.50)次,差异有统计学意义(t=-9.354、-9.367,P<0.001)。观察组创面愈合时间为(10.30±5.50)d,早于对照组的(11.88±2.50)d,差异有统计学意义(t=-2.367,P<0.05)。观察组患者治疗费用为(919.77±300.77)元,少于对照组的(1 388.00±410.52)元,差异有统计学意义(t=-5.144,P<0.001)。观察组总满意度为96%,高于对照组的62%,差异有统计学意义(χ^(2)=14.796,P<0.001)。结论:采取创新封闭伤口负压引流技术对肠造口黏膜旁感染伤口进行护理,具有换药次数和造口底盘更换次数少、伤口愈合快、患者经济费用少、满意度高、操作简单等优点。

临时性肠造口还纳145例切口感染防治经验

目的总结临时性肠造口还纳切口感染防治经验。方法回顾性分析2009—2015年我院收治的145例行临时性肠造口还纳手术病人的临床资料,比较改进预防措施前后的切口感染发生率。结果造口原因包括低位直肠癌低位吻合近侧保护性造口105例,结直肠损伤20例,吻合口漏19例,克罗恩病1例;还纳平均时间172.5d。改进预防措施前还纳术后至出院平均时间为9.7d,改进预防措施后为5.5d。改进预防措施前还纳术后切口感染发生率为16.8%(16/95),改进预防措施后为4.0%(2/50),改进后切口感染发生率明显低于改进前(χ2=3.857,P<0.05)。结论术前关闭造口,术中避免损伤肠管的无菌操作,术后严格无菌换药、加强锻炼等措施可降低临时性肠造口还纳切口感染率。

十字缝合和荷包缝合技术用于肠造口还纳手术皮肤关闭的多中心随机对照研究

目的比较十字缝合和荷包缝合技术用于保护性肠造口还纳手术后皮肤关闭的有效性。方法采用多中心前瞻性随机对照研究方法,于2013年11月至2017年12月,入组中华外科青年医师学术研究社结直肠外科研究组各成员单位的保护性肠造口还纳手术患者资料。样本量的确定采用优效性检验样本量计算,依据文献报道及前期工作基础,每组至少需要71例,两组合计需要样本量142例。术后评价切口疼痛情况、手术切口感染、切口愈合时间、术后患者满意度等。主要研究终点为切口愈合时间,次要研究终点为切口感染率、并发症发生率和患者满意度。组间比较采用独立样本t检验、重复测量方差分析、Mann-Whitney U检验、χ2检验、Fisher确切概率法等。结果十字缝合组男性45例,女性27例,年龄67(11)岁[M(QR)];荷包缝合组男性42例,女性29例,年龄65(20)岁。两组体重指数、美国麻醉医师协会分级、合并症、初始手术诊断和造口部位(回肠或结肠)、术中出血量、围手术期并发症、术后住院时间、住院费用、切口感染率、术后切口疝均无明显差异。与荷包缝合组相比,十字缝合组的手术时间较长[80(10)min比70(10)min,Z=-2.381,P=0.017],但切口愈合时间较短[17(2)d比25(4)d,Z=-10.199,P<0.01],满意度调查中的愈合时间评分[3(1)比3(1),Z=-4.526,P<0.01]和总体满意评分[25(3)比25(3),Z=-2.529,P=0.011]优于荷包缝合组。结论十字缝合与荷包缝合具有相似的切口感染率,均可有效用于造口还纳后的皮肤关闭。十字缝合技术的切口愈合时间更短,患者满意度评分更高,可作用肠造口还纳后皮肤关闭的重要技术选择。

皮下引流持续冲洗负压吸引术在肠造口还纳术后预防切口感染的前瞻性研究

目的探讨皮下引流持续冲洗负压吸引术在结直肠癌手术并肠造口患者行还纳术后预防切口感染的应用价值。方法前瞻性选择2017年2月至2018年12月佛山市第一人民医院收治的100例肠造口患者,按照随机数字表法分成两组,在肠造口还纳术中关闭切口时采用不同措施,每组50例,试验组采用皮下引流持续冲洗负压吸引装置,对照组采用传统关闭切口方法。比较两组患者的围手术期资料以及术后切口感染率。结果两组患者均采取开腹手术,无一例围手术期死亡。两组造口类型、初次造口时机、造口时间、手术时间、术中出血量比较,差异均无统计学意义。试验组患者术后住院时间为(7.0±5.7)d,术后切口感染率为2.0%(1/50),显著低于对照组的(9.5±5.6)d、16.0%(8/50),差异有统计学意义(t=-2.193,P=0.031;χ2=4.396,P=0.036)。结论皮下引流持续冲洗负压吸引术能有效降低结直肠癌肠造口还纳术患者的切口感染发生率,缩短住院时间,临床应用价值较高。