骶前间隙引流管联合皮下负压吸引在腹腔镜辅助腹会阴联合切除术中的应用研究

[Application research of presacral space drainage tube combined with subcutaneous vacuum pressure suction in the laparoscopic-assisted abdominoperineal resection].

作者信息

Chen Liqi, Zeng Changqing, Chi Liangjie, Huang Liangxiang, Li Jiandang

机构信息

Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Provincial Medical College, Fujian Medical University, Fuzhou 350001, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Aug 25;20(8):919-922.

PMID:28836255

Abstract

OBJECTIVE

To study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer.

METHODS

Clinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group: presacral space drainage tube was applied in 42 patients. Combined drainage group: presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and <15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed.

RESULTS

There were 51 males and 36 females with the mean age of 26-78(56.9±10.8) years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13(8.0±2.5) days in presacral space drainage group, and for 4-14(6.7±2.4) days in combined drainage group. The subcutaneous tube was placed for 14-24(15.8±3.0) days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7%(28/42) and 91.1%(41/45) respectively, while the perineal wound infection rate was 21.4%(9/42) and 4.4%(2/45) respectively, whose differences between two groups were both significant (χ=7.911, P=0.005 and χ=5.674, P=0.017).

CONCLUSION

Presacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has better efficacy and lower infection rate for perineal incision, which is worth wide application.

摘要

目的

探讨腹腔镜辅助腹会阴联合直肠癌根治术后会阴切口的处理方法。

方法

收集2009年6月至2014年2月行腹腔镜Miles手术治疗低位直肠癌的87例患者的临床资料并进行研究。骶前间隙引流组：42例患者应用骶前间隙引流管。联合引流组：45例患者应用骶前间隙引流管联合皮下负压吸引。联合引流组除骶前引流管外，另于皮下放置引流管并连接负压球，经会阴伤口进一步切开引流后固定于会阴伤口前外侧。皮下置管2周后，若引流液清，连续3天引流量<15 ml/d，同时超声未探及明显盆腔积液，且伤口愈合良好，无红肿，则可拔除带负压球的皮下引流管。

结果

87例患者中男51例，女36例，平均年龄26 - 78（56.9±10.8）岁。所有病例均成功完成腹腔镜Miles手术，无死亡及并发症发生。骶前间隙引流组引流管放置时间为4 - 13（8.0±2.5）天，联合引流组为4 - 14（6.7±2.4）天。皮下置管时间为14 - 24（15.8±3.0）天。骶前间隙引流组和联合引流组会阴伤口一期愈合率分别为66.7%（28/42）和91.1%（41/45），会阴伤口感染率分别为21.4%（9/42）和4.4%（2/45），两组差异均有统计学意义（χ=7.91, P=0.005；χ=5.674, P=0.017）。