经会阴盆腔引流联合侧卧位促进腹会阴切除术后会阴伤口愈合：一项前瞻性队列研究。

Transperineal pelvic drainage combined with lateral position to promote perineal wound healing after abdominoperineal resection: A prospective cohort trial.

机构信息

Department of the General Surgery.

Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China No. 218, Ziqiang Street, Nanguan District, Changchun City, Jilin Province, China.

出版信息

Medicine (Baltimore). 2022 Apr 8;101(14):e29104. doi: 10.1097/MD.0000000000029104.

DOI:10.1097/MD.0000000000029104

PMID:35446293

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9276168/

Abstract

BACKGROUND

For the rectal cancer <5 cm from anal margin, extralevator abdominoperineal resection (eAPR) has been accepted widely by surgeons. However, the rate of perineal infection following up eAPR is approximately 70%. We did the study with the aim of evaluating the effect and safety of transperineal pelvic drainage combined with lateral position (TPDLP) on perineal wound in patients undergoing eAPR.

METHODS

Patients were randomly assigned to N-TPDLP group (standard arm) or TPDLP group (intervention arm). In the standard arm, surgery was completed after abdominal drainage tube was placed in pelvic. Comparatively, an additional transperineal wound drainage tube was applied in the experimental arm. Postoperatively, patients of both 2 groups were informed not to sit to reduce perineal compression until the perineal wound healed. But lateral position was demanded in the intervention arm. The primary endpoint was the rate of uncomplicated perineal wound healing defined as a Southampton wound score of <2 at 30 days postoperatively. Patients were followed for 6 months.

RESULTS

In total, 60 patients were randomly assigned to standard arm (n = 31) and intervention arm (n = 29). The mean perineal wound healing time was 34.2 (standard deviation [SD] 10.9) days in TPDLP arm, which significantly differ from 56.4 (SD 34.1) in N-TPDLP arm (P = .001). At 30 days postoperatively, 3 (10%) of 29 patients undergoing TPDLP were classified into grade 4 according to Southampton wound score, however, 16 (52%) of 31 patients were classified into grade 4 in control arm, and significantly difference was observed between randomization groups (P = .001). What's more, perineal wound pain was assessed at 30 days postoperatively, and it is discovered that the pain degree of patients in control arm was significantly more severe than the interventive arm (P = .015).

CONCLUSION

In the present study, we found that TPDLP generated a favorable prognosis for perineal wounds with acceptable side-effects.

摘要

背景

对于距肛门边缘<5cm 的直肠癌，经肛提肌外腹会阴联合切除术（eAPR）已被外科医生广泛接受。然而，eAPR 后会阴部感染的发生率约为 70%。我们进行这项研究旨在评估经会阴盆腔引流联合侧卧位（TPDLP）对接受 eAPR 患者会阴伤口的效果和安全性。

方法

患者随机分为 N-TPDLP 组（标准组）或 TPDLP 组（实验组）。在标准组中，腹部引流管放置在盆腔后完成手术。相比之下，实验组额外应用经会阴伤口引流管。两组患者术后均告知避免坐位，直至会阴伤口愈合，以减少会阴压迫。但实验组要求采用侧卧位。主要终点是定义为术后 30 天会阴伤口评分<2 的无并发症会阴伤口愈合率。患者随访 6 个月。

结果

共 60 例患者随机分为标准组（n=31）和实验组（n=29）。实验组的会阴伤口愈合时间平均为 34.2（标准差 [SD] 10.9）天，明显短于标准组的 56.4（SD 34.1）天（P=.001）。术后 30 天，实验组 29 例患者中有 3 例（10%）按 Southampton 伤口评分分级为 4 级，而对照组 31 例患者中有 16 例（52%）分级为 4 级，两组间差异有统计学意义（P=.001）。此外，术后 30 天评估会阴伤口疼痛，发现对照组患者疼痛程度明显重于实验组（P=.015）。