Han Jiagang, Wang Zhenjun, Wei Guanghui, Zhai Zhiwei, Ma Liangang, Yi Bingqiang, Zhao Baocheng
Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China.
Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China, Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Dec 25;21(12):1403-1407.
To compare the safety and feasibility between modified circumferential purse-string closure and conventional primary linear closure of the wound following loop stoma reversal.
Clinical data of 88 consecutive patients who underwent loop colostomy or loop ileostomy closures at our hospital from July 2011 to June 2013 were retrospectively analyzed. Among them, 43 cases underwent modified purse-string technique (modified purse-string group), 45 cases underwent direct suture (direct suture group). The operation method of modified purse-string suture was as follows: (1) the circumferential subcutaneous adipose tissue was sutured with the absorbable suture, avoiding tightening at knotting and retaining a 1 cm pore;(2)absorbable suture was used to perform purse-string suture of the dermis, retaining a 0.5 cm central pore when knotting; (3) a rubber drain was placed through the pore. The clinical parameters, surgical results and postoperative complication of two groups were recorded and compared.
There were 56 males and 32 females with age of (65.0±11.5) years old. Seventy-nine cases were malignant tumors, 6 were benign tumors and 3 were traumatic. There was no significant difference in the baseline data between two groups (all P>0.05). Compared with the direct suture group, the modified purse-string group had significantly lower wound infection rate [7.0%(3/43) vs. 24.4%(11/45), χ²=5.015, P=0.025]; significantly shorter postoperative hospital stay (mean 7.1 days vs. 8.6 days, t=-2.656, P=0.010); significantly lower total hospitalization costs (mean 25 668.4 yuan vs. 27 718.1 yuan, t=-2.488, P=0.015); however, the wound healing time of the modified purse-string group was significantly longer (mean 22.0 days vs. 13.0 days, t=5.701, P<0.001). The average healing time of the wounds in the direct suture group was 29.8 days, which was significantly longer than that of the first-stage healing cases (7.5 days, t=-15.446,P<0.001). The average wound healing time of the infected cases in the modified purse-string suture group was 22.0 days, compared with 22.1 days in the first-stage healing cases, the difference was not statistically significant(t=0.077,P=0.943).
Modified purse-string closure after loop stoma reversal is an appropriate technique with lower stoma site infection rate, shorter postoperative hospital stay and lower hospitalization cost than conventional primary closure, although wounds may take longer to heal in this approach.
比较改良环形荷包缝合与传统一期直线缝合在袢式造口回纳术后伤口处理的安全性和可行性。
回顾性分析2011年7月至2013年6月在我院连续接受袢式结肠造口或袢式回肠造口关闭术的88例患者的临床资料。其中，43例采用改良荷包技术（改良荷包组），45例采用直接缝合（直接缝合组）。改良荷包缝合的手术方法如下：（1）用可吸收缝线缝合环形皮下脂肪组织，打结时避免收紧，保留1cm孔隙；（2）用可吸收缝线进行真皮荷包缝合，打结时保留0.5cm中央孔隙；（3）通过孔隙放置橡胶引流管。记录并比较两组的临床参数、手术结果和术后并发症。
患者共88例，男性56例，女性32例，年龄（65.0±11.5）岁。其中恶性肿瘤79例，良性肿瘤6例，外伤3例。两组基线资料比较差异无统计学意义（均P>0.05）。与直接缝合组相比，改良荷包组伤口感染率显著降低[7.0%（3/43）比24.4%（11/45），χ²=5.015，P=0.025]；术后住院时间显著缩短（平均7.1天比8.6天，t=-2.656，P=0.010）；总住院费用显著降低（平均25668.4元比27718.1元，t=-2.488，P=0.015）；然而，改良荷包组伤口愈合时间显著延长（平均22.0天比13.0天，t=5.701，P<0.001）。直接缝合组伤口平均愈合时间为29.8天，显著长于一期愈合病例（7.5天，t=-15.446，P<0.001）。改良荷包缝合组感染病例伤口平均愈合时间为22.0天，与一期愈合病例的22.1天相比，差异无统计学意义（t=0.077，P=0.943）。
袢式造口回纳术后改良荷包缝合是一种合适的技术，与传统一期缝合相比，造口部位感染率更低，术后住院时间更短，住院费用更低，尽管这种方法伤口愈合时间可能更长。
