Department of Gastrointestinal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Tech Coloproctol. 2017 Sep;21(9):715-720. doi: 10.1007/s10151-017-1695-8. Epub 2017 Oct 12.
The aim of our study was to assess perineal wound healing in patients with Crohn's disease (CD) who undergo proctectomy or proctocolectomy with end ileostomy and to evaluate the influence of various factors including types of perineal dissection on eventual wound healing.
Data for patients with CD who underwent proctectomy or total proctocolectomy with end ileostomy from 1995 to 2012 were reviewed. The relationship between perineal wound healing and demographics, patient characteristics, and other factors was assessed using univariate and multivariate analyses.
The perineal wound healed by 12 weeks in 72 (52.9%) out of 136 patients (63.2% female, mean age 41 ± 13 years); delayed healing occurred in 35 patients (25.7%), and in 29 patients (21.3%), there was non-healing. On multivariate analysis, the only factor associated with delayed healing and non-healing was preoperative perineal sepsis (p = 0.001).
After proctectomy or proctocolectomy for CD, perineal wound healing is poor and poses a particular challenge for patients with preoperative perineal sepsis. These findings support a preoperative discussion regarding CD patients that examines potential outcomes and the consideration of measures such as the initial creation of defunctioning ostomy or control/drainage of local sepsis prior to proctectomy.
本研究旨在评估患有克罗恩病（CD）的患者在接受直肠切除术或直肠结肠切除术伴末端回肠造口术后的会阴伤口愈合情况，并评估各种因素（包括会阴解剖类型）对最终伤口愈合的影响。
回顾了 1995 年至 2012 年间接受直肠切除术或全直肠结肠切除术伴末端回肠造口术的 CD 患者的数据。使用单因素和多因素分析评估会阴伤口愈合与人口统计学、患者特征和其他因素之间的关系。
136 例患者中有 72 例（52.9%）在 12 周内会阴伤口愈合（63.2%为女性，平均年龄 41 ± 13 岁）；35 例患者出现延迟愈合，29 例患者出现不愈合。多因素分析显示，术前会阴脓毒症是唯一与延迟愈合和不愈合相关的因素（p=0.001）。
在患有 CD 的患者中，接受直肠切除术或直肠结肠切除术治疗后，会阴伤口愈合不良，这对术前会阴脓毒症患者构成了特殊挑战。这些发现支持在术前对 CD 患者进行讨论，以评估潜在的结果，并考虑在直肠切除术前采取措施，如初始建立预防性肠造口或控制/引流局部脓毒症。
