Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Dis Colon Rectum. 2014 Feb;57(2):143-50. doi: 10.1097/DCR.0000000000000027.
Abdominoperineal resection for low rectal adenocarcinoma is a common procedure with high morbidity, including perineal wound complications.
The purpose of this study was to determine risk factors for perineal wound dehiscence and to investigate the effect of wound dehiscence on survival.
This was a retrospective medical chart review.
The study was conducted in a tertiary care university medical center.
Patients included in the study were those with low rectal adenocarcinoma who underwent abdominoperineal resection between January 2001 and June 2012.
We assessed the incidence of perineal wound dehiscence, as well as survival, after surgery.
A total of 249 patients underwent abdominoperineal resection for rectal carcinoma. The mean age was 62.6 years (range, 23.0-98.0 years), 159 (63.8%) were male, and the mean BMI was 27.9 (range, 16.7-58.5). There were 153 patients (61.1%) who survived for 5 years after surgery. Sixty-nine patients (27.7%) developed wound dehiscence. Multivariable analysis revealed the following associations with dehiscence: BMI (OR, 1.09; 95% CI, 1.03-1.15; p = 0.002), IBD (OR, 6.6; 95% CI, 1.4-32.5; p = 0.02), history of other malignant neoplasm (OR, 3.1; 95% CI, 1.5-6.6), and abdominoperineal resection for cancer recurrence (OR, 2.8; 95% CI, 1.2-6.3; p = 0.01). In the survival analysis, wound dehiscence was associated with decreased survival (mean survival time for dehiscence vs no dehiscence, 66.6 months vs 76.6 months; p = 0.01). This relationship persisted in the multivariable analysis (HR, 1.7; 95% CI, 1.1-2.8; p = 0.02).
This was a retrospective, observational study from a single center.
The adjusted risk of death was 1.7 times higher in patients who experienced dehiscence than in those who did not. Attention to perineal wound closure with consideration of flap creation should at least be given to patients with a history of malignant neoplasm, those with IBD, those with rectal cancer recurrence, and women undergoing posterior vaginectomy. Preoperative weight loss should also reduce dehiscence risk.
经腹会阴联合切除术治疗低位直肠腺癌是一种常见的高发病率手术，包括会阴伤口并发症。
本研究旨在确定会阴伤口裂开的危险因素，并探讨伤口裂开对生存的影响。
这是一项回顾性病历回顾研究。
研究在一家三级护理大学医学中心进行。
纳入研究的患者为 2001 年 1 月至 2012 年 6 月期间接受经腹会阴联合切除术的低位直肠腺癌患者。
我们评估了手术后会阴伤口裂开的发生率和生存情况。
共有 249 例患者因直肠癌接受经腹会阴联合切除术。平均年龄为 62.6 岁（范围，23.0-98.0 岁），159 例（63.8%）为男性，平均 BMI 为 27.9（范围，16.7-58.5）。术后 5 年有 153 例（61.1%）患者存活。69 例（27.7%）发生伤口裂开。多变量分析显示与裂开相关的因素有：BMI（OR，1.09；95%CI，1.03-1.15；p=0.002）、炎症性肠病（OR，6.6；95%CI，1.4-32.5；p=0.02）、其他恶性肿瘤病史（OR，3.1；95%CI，1.5-6.6）和因癌症复发而行经腹会阴联合切除术（OR，2.8；95%CI，1.2-6.3；p=0.01）。在生存分析中，伤口裂开与生存率降低相关（裂开组和未裂开组的平均生存时间分别为 66.6 个月和 76.6 个月；p=0.01）。这种关系在多变量分析中仍然存在（HR，1.7；95%CI，1.1-2.8；p=0.02）。
这是一项来自单一中心的回顾性观察性研究。
与未发生裂开的患者相比，发生裂开的患者的死亡调整风险高 1.7 倍。对于有恶性肿瘤病史、炎症性肠病病史、直肠癌复发、接受后阴道切除术的患者，应特别注意会阴伤口闭合，并考虑皮瓣的形成。术前体重减轻也应降低裂开的风险。
