荷包缝合术与带引流管的一期缝合术用于造口回纳手术的比较：一项随机临床试验的结果
Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trial.
作者信息
Amano Kunihiko, Ishida Hideyuki, Kumamoto Kensuke, Okada Norimichi, Hatano Satoshi, Chika Noriyasu, Tajima Yusuke, Ohsawa Tomonori, Yokoyama Masaru, Ishibashi Keiichiro, Mochiki Erito
机构信息
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kagawa, Japan.
出版信息
Surg Today. 2019 Mar;49(3):231-237. doi: 10.1007/s00595-018-1729-5. Epub 2018 Oct 26.
PURPOSE
Stoma reversal carries a risk of surgical site infection (SSI). Purse-string approximation (PSA) has been reported as an attractive alternative to conventional primary wound closure for stoma reversal, but its efficacy is still under debate.
METHODS
Patients undergoing elective stoma reversal were randomized to undergo PSA or primary closure with a drain (PCD). All patients received preoperative bowel cleansing and antimicrobial prophylaxis. The primary endpoint was the incidence of wound healing at the stoma site 30 days after surgery. The secondary endpoint was the 30-day SSI rate after surgery.
RESULTS
A total of 159 patients (PCD group, n = 79; PSA group, n = 80) were eligible for this study. The incidence of wound healing at the stoma site was 92.4% in the PCD group and 62.5% in the PSA group [difference (95% confidence interval - 29.9% (- 42.9 to - 16.9%)]. The 30-day SSI rate at the stoma site, as the secondary endpoint, was 8.9% in the PCD group and 5.0% in the PSA group (P = 0.35).
CONCLUSIONS
These results suggest that PCD may remain the standard procedure for stoma reversal surgery.
目的
造口回纳术存在手术部位感染（SSI）的风险。荷包缝合术（PSA）已被报道为造口回纳术替代传统一期伤口缝合的一种有吸引力的方法，但其疗效仍存在争议。
方法
将择期行造口回纳术的患者随机分为接受PSA组或带引流管一期缝合（PCD）组。所有患者均接受术前肠道准备和抗菌预防。主要终点是术后30天造口部位伤口愈合的发生率。次要终点是术后30天的SSI发生率。
结果
共有159例患者（PCD组，n = 79；PSA组，n = 80）符合本研究条件。PCD组造口部位伤口愈合的发生率为92.4%，PSA组为62.5%[差异（95%置信区间 - 29.9%（- 42.9至 - 16.9%）]。作为次要终点，PCD组造口部位30天SSI发生率为8.9%，PSA组为5.0%（P = 0.35）。
结论
这些结果表明，PCD可能仍是造口回纳手术的标准术式。
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