Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland.
Research Service Unit, Oulu University Hospital, Oulu, Finland.
BMC Surg. 2022 Jul 30;22(1):296. doi: 10.1186/s12893-022-01746-1.
Perineal wound complications are common after abdominoperineal resection (APR) for rectal adenocarcinoma. Delayed wound healing may postpone postoperative adjuvant therapy and, therefore, lead to a worse survival rate. Negative-pressure wound therapy (NPWT) has been suggested to improve healing, but research on this subject is limited.
The aim of this study was to assess whether NPWT reduces surgical site infections (SSI) after APR for rectal adenocarcinoma when the closure is performed with a biological mesh and a local flap. A total of 21 consecutive patients had an NPWT device (Avelle, Convatec™) applied to the perineal wound. The study patients were compared to a historical cohort in a case-control setting in relation to age, body mass index, tumor stage, and length of neoadjuvant radiotherapy. The primary outcome was the surgical site infection rate. The secondary outcomes were the wound complication rate, the severity of wound complications measured by the Clavien-Dindo classification, length of hospital stay, and surgical revision rate.
The SSI rate was 33% (7/21) in the NPWT group and 48% (10/21) in the control group, p = 0.55. The overall wound complication rate was 62% (13/21) in NPWT patients and 67% (14/21) in the control group, p > 0.90. The length of hospital stay was 15 days in the NPWT group and 13 in the control group, p = 0.34. The wound severity according to the Clavien-Dindo classification was 3b in 29% (6/21) of the NPWT group and in 38% (8/21) of the control group. A surgical revision had to be performed in 29% (6/21) of the cases in the NPWT group and 38% (8/21) in the control group, p = 0.73.
NPWT did not statistically decrease surgical site infections or reduce wound complication severity in perineal wounds after APR in this case-control study. The results may be explained by technical difficulties in applying NPWT in the perineum, especially in female patients. NPWT devices should be further developed to suit the perineal anatomy before their full effect can be assessed. Trial registration The study was registered as a prospective registry study (266/2018, registered 15th of November 2018).
经腹会阴联合切除术（APR）治疗直肠腺癌后，会阴伤口并发症较为常见。伤口愈合延迟可能会延迟术后辅助治疗，从而导致生存率下降。负压伤口治疗（NPWT）已被证明可以促进愈合，但该领域的研究有限。
本研究旨在评估在使用生物补片和局部皮瓣进行会阴切口缝合时，NPWT 是否能降低直肠腺癌 APR 术后的手术部位感染（SSI）发生率。共 21 例连续患者使用 Avelle（康维德）NPWT 装置进行会阴伤口处理。在病例对照研究中，将研究患者与历史队列中的患者进行比较，比较因素包括年龄、体重指数、肿瘤分期和新辅助放疗长度。主要结局是 SSI 发生率。次要结局是伤口并发症发生率、伤口并发症严重程度（采用 Clavien-Dindo 分级）、住院时间和手术修正率。
NPWT 组的 SSI 发生率为 33%（7/21），对照组为 48%（10/21），p=0.55。NPWT 组的总体伤口并发症发生率为 62%（13/21），对照组为 67%（14/21），p＞0.90。NPWT 组的住院时间为 15 天，对照组为 13 天，p=0.34。NPWT 组中根据 Clavien-Dindo 分级的伤口严重程度为 3b 的占 29%（6/21），对照组为 38%（8/21）。NPWT 组中有 29%（6/21）的病例需要进行手术修正，对照组为 38%（8/21），p=0.73。
在这项病例对照研究中，NPWT 并没有在统计学上降低 APR 后会阴伤口的 SSI 发生率或减轻伤口并发症的严重程度。结果可能是由于 NPWT 在会阴部位应用时存在技术困难，尤其是在女性患者中。在充分评估 NPWT 的效果之前，应该进一步开发 NPWT 设备以适应会阴解剖结构。
该研究作为一项前瞻性注册研究进行注册（266/2018，于 2018 年 11 月 15 日注册）。
