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[单腔回肠造口术的两针连续缝合方法]

[A two-stitch continuous suture method for single-lumen ileostomy].

作者信息

Lan Q N, Yu J L, Yu J, Luo G Z, Zou Q, Zou Z W

机构信息

Department of General Surgery, Zhujiang Hospital of Southern Medical University,Guangzhou 510220,China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Nov 25;25(11):1020-1024. doi: 10.3760/cma.j.cn441530-20220810-00342.

Abstract

To explore the value of a two-stitch continuous suture in single- lumen ileostomy. This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, =60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, =38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. There were no significant differences in baseline data between the groups (all, >0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; =-17.874;<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ=9.633, =0.002;5.3% (2/38) vs. 28.3% (17/60), χ=7.923, =0.005; and 2.6% (1/38) vs. 18.3% (11/60), =0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all >0.05). Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.

摘要

探讨双针连续缝合法在单腔回肠造口术中的应用价值。这是一项回顾性队列研究。回顾性收集了2021年1月1日至2022年5月1日在南方医科大学珠江医院接受单腔肠造口术的98例患者的数据。所有患者均符合预防性单腔回肠造口术的指征。排除年龄大于80岁、基础疾病复杂、全身状况极差无法耐受手术、肠管末端血供差以及肠管末端严重水肿或严重感染者。在纳入的患者中,2021年10月1日前接受手术的患者采用间断缝合法行回肠造口术(对照组,n = 60),2021年10月1日及以后接受手术的患者常规采用双针连续缝合法行回肠造口术(双针造口组,n = 38)。双针连续缝合法行回肠造口术操作如下:第一针连续缝合从深层至浅层依次缝合肠管浆肌层、腹膜、后鞘和前鞘。然后切开肠壁。第二针连续缝合肠管全层与皮肤。比较两组术后造口相关并发症及手术时间的差异。两组基线数据无显著差异(均P>0.05)。双针造口组手术时间短于对照组(分别为16.6±2.2分钟和25.1±2.4分钟;t = -17.874;P<0.001)。双针造口组黏膜皮肤分离、皮炎及造口回缩的发生率低于对照组[5.3%(2/38)比31.7%(19/60),χ² = 9.633,P = 0.002;5.3%(2/38)比28.3%(17/60),χ² = 7.923,P = 0.005;2.6%(1/38)比18.3%(11/60),P = 0.026],而两组造口旁疝和造口脱垂的发生率以及术后视觉模拟评分相似(均P>0.05)。与传统单腔回肠造口术相比,双针连续缝合法行回肠造口术具有手术时间短、操作简单、造口美观以及显著降低回肠造口术后并发症的优点。

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