Miles术后会阴部切口感染的临床分析

目的研究Miles术后会阴部切口是否放置引流对会阴切口感染的影响,探索Miles术后会阴切口感染的防治方法。方法分析34例Miles术后是否放置会阴部引流和如何放置会阴部引流对会阴部切口愈合的影响及会阴部切口感染愈合的影响因素。结果未置会阴部引流的切口感染率为60%（3/5）。会阴部放置合适引流后,切口感染率明显下降,约20%左右（6/29）。一旦切口发生感染后,切口愈合的时间较长（40±5d）。结论 Miles术后放置会阴部尾骨前引流可明显降低会阴部切口感染及裂开的发生率。     

肝内胆管结石手术切口感染危险因素分析

目的：分析肝内胆管结石术后切口感染的危险因素,为降低术后切口感染发生率提供有效预防措施。 方法：回顾性分析2005年7月—2012年12月间手术117例治疗肝内胆管结石患者临床资料,根据患者是否接受预防切口感染的特殊围手术期处理分为特殊处理组与常规处理组,比较两组患者术后切口感染发生率及其他临床指标;再根据患者是否发生切口感染将患者分为感染组与非感染组,分析引起切口感染的危险因素。 结果：与常规处理组比较,特殊处理组术后切口感染发生率明显降低（14.6% vs. 36.8%）,引流管拔除时间、抗生素使用时间、术后住院时间明显缩短、住院费用明显减少（均P<0.05）。单因素分析显示,术后切口感染与年龄、合并糖尿病、术前胆管炎、既往胆道手术史、胆汁培养阳性、术中采取预防措施、手术时间、拔除引流管时间有关（均P<0.05）;多因素分析显示,合并糖尿病、既往胆道手术史和延迟拔除引流管是术后切口感染的危险因素,而术中采取预防措施是保护性因素（均P<0.05）。 结论：合并糖尿病、既往胆道手术史和术后延迟拔除引流管是术后切口感染的独立危险因素,而术中采取预防措施可降低肝内胆管结石患者术后切口感染发生率,且有利于患者快速康复。

     

结直肠癌术后切口感染危险因素的Logistic回归分析

目的研究和分析结直肠癌术后切口感染的危险因素,为有效降低结直肠癌术后感染风险提供参考依据。方法回顾性分析本院2016年1月~2017年12月期间203例行结直肠癌手术患者的临床资料,采用Logistic回归模型分析术后切口感染的独立危险因素。结果 203例患者中,发生术后切口感染者30例,切口感染发生率为14.778%。经Logistic单因素分析结果显示,术后切口感染与患者手术部位、切口类型、急诊手术、麻醉评分分级、手术风险分级、住院时间和合并糖尿病有关(均P0.05);Logistic多因素分析结果显示,切口类型、住院时间和合并糖尿病为术后切口感染的独立危险因素(均P0.05)。结论手术切口类型、住院时间和合并糖尿病为结直肠癌术后切口感染的独立危险因素,在临床工作中应加强对风险因素的评估和干预,使患者更好的恢复。     

直肠癌Miles术后会阴切口的处理方式分析及护理对策

为探讨理想的直肠癌Miles术后会阴部切口处理方式及护理对策,将2019年2月至2020年2月于我院拟行Miles术治疗的100例直肠癌患者随机分为A组和B组,各50例,A组术后会阴切口予以一期缝合,B组术后会阴切口开放填塞.比较2组患者术后会阴切口感染、出血情况及创面愈合时间.结果显示,A组术后会阴切口感染发生率(1...     

手辅助腹腔镜结直肠癌术后切口疝的发生危险因素分析

目的:探讨手辅助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌术后切口疝发生的相关危险因素,为预防术后切口疝的发生提供证据。方法:回顾分析2009年8月至2012年8月为142例患者行HALS结直肠癌切除术的临床资料,至随访结束时,根据手辅助口位置是否发生切口疝将患者分为切口疝组及无切口疝组,分析两组患者年龄、性别、体质指数(body mass index,BMI)、吸烟、伴随疾病、辅助切口位置、切口长度、是否感染等与切口疝发生相关的危险因素。结果:入选的142例患者中,13例至随访结束时发生切口疝,发生率为9.2%,合并糖尿病的患者术后切口疝发生率明显高于无糖尿病患者(P<0.01),切口疝组患者平均BMI、吸烟率亦高于无切口疝组,与左下腹低位横切口相比,正中切口术后疝的发生率较高。结论:肥胖、吸烟、糖尿病、切口位置与切口疝的发生密切相关,充分的围手术期准备,可有效减少切口疝的发生。     

腰椎后路融合内固定术后手术切口感染的危险因素分析

目的 探讨腰椎后路融合内固定术后手术切口感染的相关危险因素。方法 将177例行腰椎后路融合内固定术患者根据手术切口是否发生感染分为感染组（11例）和非感染组（166例）。对两组基本资料进行单因素分析,对单因素分析具有显著差异的因素进行二元logistic回归分析。结果 单因素分析显示：两组皮下脂肪厚度、合并糖尿病、吸烟、术前白蛋白、术后白蛋白、手术时间、手术节段、术后脑脊液漏比较差异均有统计学意义（P<0.05）。二元logistic回归分析结果显示：皮下脂肪厚度≥3 cm、合并糖尿病、手术时间≥3 h、术后脑脊液漏是腰椎后路融合内固定术后手术切口感染的独立危险因素。结论 皮下脂肪厚度≥3 cm、合并糖尿病、手术时间≥3 h、术后脑脊液漏的患者行腰椎后路融合内固定术发生手术切口感染的风险较大。     

腰椎后路融合术后急性手术部位感染的危险因素分析

目的探讨腰椎后路融合术后发生急性手术部位感染的相关危险因素。方法回顾性分析2016年1月至2018年12月于我院脊柱外科行腰椎后路融合手术的330例病人的临床资料。病人主要诊断包括腰椎椎管狭窄、腰椎间盘突出症、腰椎骨折、肿瘤等。根据术后是否发生急性手术部位感染将病人分为感染组和非感染组,选择年龄、性别、身体质量指数(body mass index, BMI)、吸烟、高血压、糖尿病、骨质疏松症、手术节段数、手术时间、出血量、切口长度、术后引流时间、尿路感染和脑脊液漏等可能影响术后急性手术部位感染的因素,先后应用单因素分析和二元Logistic回归分析腰椎后路融合术后急性手术部位感染的危险因素。结果共有19例术后发生了急性手术部位感染,发生率为5.76%(19/330)。单因素分析结果显示:两组病人的年龄、BMI、糖尿病、骨质疏松、手术节段、手术时间、出血量、脑脊液漏、尿路感染以及切口长度的差异均有统计学意义(P均<0.05)。二元Logistic回归分析结果显示:BMI[OR=1.429,95%CI(1.059,1.929),P=0.020]、合并糖尿病[OR=9.568,95%CI(2.183,41.935),P=0.003]、手术时间[OR=8.868,95%CI(1.992,39.482),P=0.004]、切口长度[OR=7.257,95%CI(2.937,16.719),P<0.001]为腰椎后路融合术后急性手术部位感染的独立危险因素。结论为了降低腰椎术后急性手术部位感染的发生率,围术期应合理评估控制相关危险因素,以获得更好的治疗效果和病人满意度。     

腰椎融合术后切口深部感染的危险因素分析

【摘要】 目的：回顾分析腰椎后路手术深部切口感染与同期手术无感染者的临床资料,探讨深部切口感染的危险因素。方法：回顾分析2013年1月~2018年12月我院脊柱外科接受腰椎后路固定融合术且随访1年以上的腰椎退变性疾病患者。收集所有患者的病历资料,根据切口深部感染诊断标准确定术后深部切口感染病例,将患者分为感染组与非感染组。采用单因素和多因素Logistic回归对两组患者的手术时年龄、性别、体重指数（body mass index,BMI）、吸烟、饮酒、糖尿病、高血压、痛风、尿路感染、肺部疾病,术前血液学指标,手术相关因素,输血量、术后白蛋白、术后留置尿管时间进行分析,确定深部切口感染的危险因素。结果：共有907例患者纳入研究,其中符合切口深部感染诊断标准的患者共20例,男女各10例,平均年龄58.9±7.8岁。单因素分析显示年龄、BMI、饮酒、糖尿病、尿路感染、输血与感染相关;多因素Logistic回归分析（Backward LR法）显示BMI>25kg/m2（P=0.031）,既往饮酒（P=0.049）,糖尿病（P=0.006）,尿路感染（P<0.001）,术后引流少（P=0.040）,术后输血（P=0.001）是发生深部切口感染的独立危险因素。其中尿路感染、糖尿病、饮酒病史、高BMI是深部切口感染的四个主要的独立危险因素（OR分别为14.92、5.53、3.10、2.78）。结论：术前尿路感染、糖尿病、饮酒病史、BMI>25kg/m2以及术后引流少、输血多是腰椎退行性疾病后路固定融合术后深部切口感染的独立危险因素,针对这些危险因素制定相应的措施,有助于降低切口感染率。     

经尿道前列腺电切术后出血的危险因素分析

目的探讨经尿道前列腺电切术(TURP)后出血的危险因素。方法选取2014-03—2017-06间在丰顺县人民医院接受TURP治疗的87例良性前列腺增生(BPH)患者。根据术后是否出血分为出血组和未出血组,对患者的一般资料行单因素和多因素Logistic回归分析,探讨TURP术后出血的危险因素。结果 87例患者术后并发出血11例(12.64%)。单因素分析得出,合并糖尿病和泌尿系感染、组织残留、膀胱痉挛、尿管滑出、冲洗液温度低、腹压增高、术后过早活动、术后感染在出血组和非出血组中比较有统计学意义(P0.05)。多因素分析得出,合并糖尿病及泌尿系感染、组织残留、膀胱痉挛、尿管滑出、冲洗液温度低、腹压增高、术后过早活动及感染为影响术后出血的危险因素。结论影响TURP术后出血的危险因素较多,应根据相关危险因素针对性进行预防和干预,以降低术后出血发生率。     

200例非肌层浸润性膀胱癌复发及进展的危险因素分析

目的分析200例非肌层浸润性膀胱癌(NMIBC)复发及进展的危险因素。方法对2012-01—2015-12间在郑州大学第一附属医院进行治疗的200例经病理证实为NMIBC患者的临床资料进行回顾性分析。所有患者均进行经尿道膀胱肿瘤切除术(TURBT)治疗,并进行随访,从年龄、性别、肿瘤数目、大小、分期、分级、术后是否即刻膀胱灌注化疗等多方因素进行分析。结果患者术后均随访12~59个月,平均33.4个月。复发70例(35.00%),进展28例(14.00%)。单因素分析结果表明,肿瘤数目、大小、分期、分级、术后是否即刻膀胱灌注化疗等因素与患者复发、病情进展相关(P0.05)。经多因素分析发现,肿瘤数目、大小、分期、分级、术后是否即刻膀胱灌注化疗并非导致患者病情进展的独立危险因素(OR1)。结论肿瘤数目、大小、分期、分级、术后是否即刻膀胱灌注化疗均是NMIBC患者复发与病情进展的危险因素,临床应加以重视。     

Incisional negative pressure wound therapy to reduce perineal wound infection after abdominoperineal resection

We explored the effects of incisional negative pressure wound therapy in perineal wound infections after abdominoperineal resection. We retrospectively evaluated 146 patients who underwent abdominal perineal resection from December 2004 to December 2019 and compared conventional gauze dressing (controls) with incisional negative pressure wound therapy. We compared patients' characteristics, surgical factors, and perineal infection rates between groups, and patients' characteristics, surgical factors, and negative pressure therapy use between perineal infection vs non‐infection groups, as well as the risk factors for perineal infections. In the negative pressure therapy group, compared with controls, the number of men, smoking prevalence, blood transfusion, drainage via the perineal wound, and intraoperative blood loss were significantly lower (p < 0.05, p < 0.05, p < 0.05, p < 0.001, p < 0.01, respectively), and operation time was significantly longer (p < 0.05). Infections were significantly less common in the negative pressure group (p < 0.05). In the univariate analysis, the infection‐positive group had significantly higher laparoscopic surgery (p < 0.01) and negative pressure wound therapy‐free rates (p < 0.01), and significantly more intraoperative blood loss (p < 0.05). Multivariate analysis using these three factors and preoperative radiotherapy showed that incisional negative pressure wound therapy‐free status was a risk factor for infection. Incisional negative pressure wound therapy was beneficial in managing perineal wound infections after abdominoperineal resection.     

Abdominoperineal resection without an abdominal incision for rectal cancer has the advantage of no abdominal wound complication and easier stoma care

Abdominoperineal resection has been used for years for the management of low rectal cancer. However, the abdominal incision is associated with many complications and causes interference of the stoma care. If the abdominal incision can be avoided, it would be beneficial to the patient. The aim of the study is to evaluate the possibility and safety of performing abdominoperineal resection and the oncology result without an abdominal incision. From September 2001 to May 2010, 40 patients with rectal malignancies received excision of the rectum, anus, and perineum through a perineal incision and a skin hole created for stomy. No harmonic scalpel or laser was used during surgery. No laparoscope or hand port was used in the procedure. There were 19 males and 21 females. Age ranged from 31 to 87 years old (average, 62.9 years). There were 39 adenocarcinomas and one malignant gastrointestinal stromal cell tumor. There was no operative mortality. Six patients had postoperative complications; three patients had intestinal obstructions; and one patient each had bleeding, urinary tract infection, and colostomy separation from the skin. The lymph nodes in the specimens ranged from 9 to 33 cm (average, 16.8 cm). The survival is similar to the traditional abdominoperineal resection. This limited experience suggests that an abdominal incision is not necessary for radical resection of the rectum, anus, and perineum in patients with low-lying rectal cancer. It also offers the patient easier care of stoma without interference of the abdominal incision.     

The bottom end. Handling of the perineal wound after abdominoperineal resection

There are a number of options for handling the perineal wound following abdominoperineal resection, including open packing or primary closure with suction drainage. Open packing has not been widely accepted, fearing that it may delay perineal wound healing. The purpose of this paper, therefore, was to retrospectively evaluate, the experience at Ferguson Hospital with abdominoperineal resection from 1977 through 1986. The study population consisted of 288 patients undergoing abdominoperineal resection for rectal adenocarcinoma. Forty-six patients had the perineal wound closed primarily and 242 had the perineal wound packed open. Ninety-four patients had the pelvic peritoneum left open and 194 underwent closure of the pelvic peritoneum. Overall operative mortality was 2.1 per cent, and there was no significant difference between primary closure and open packing of the perineal wound with respect to hospital stay, operating time, operative blood loss, perioperative mortality, incidence of postoperative bowel obstruction, incidence of postoperative complications, or average time for perineal wound healing. Therefore, it would appear that packing the perineal wound following abdominoperineal resection is a viable means of handling the bottom end.     

Late occurrence of perineal wound abscess years after total colectomy

Seven patients presented with a large perineal abscess eight months to seven years after complete healing of the perineal wound following proctocolectomy. Six patients had had total proctocolectomies for ulcerative colitis and a seventh had undergone abdominoperineal resection for cancer. A typical clinical picture of perineal pain, fever, urinary tract complaints (including retention), and minimal local perineal findings was present. Prostatitis or a urinary tract infection was considered in five patients, but none of them responded to antibiotics. Ultrasound examination of the perineum may confirm the diagnosis; however, diagnostic and therapeutic surgical exploration of the healed perineum is recommended when this diagnosis is unclear.     

Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma

OBJECTIVE: Nonhealing perineal wound is an unpleasant complication of surgical excision of the rectum and anus. The aim of the study was to evaluate the risk factors for impaired perineal wound healing after abdominoperineal resection (APR) of rectum for adenocarcinoma, particularly with the increasing use of neo-adjuvant chemoradiation. METHOD: The study included 38 consecutive patients (29 men, nine women; median age 66 years, range: 43-86), who underwent surgical excision of rectum and anus for adenocarcinoma from 1999 to 2004. Thirty-seven patients underwent APR of rectum and one patient, who developed carcinoma in the background of chronic ulcerative colitis, had panproctocolectomy. Associations between the failure of the perineal wound to heal and a number of patient, tumour and treatment-related variables were evaluated by Pearson chi-square test or Fisher's exact test, as appropriate. A P-value of <0.05 was considered significant. Multivariate statistical technique of principal component analysis was also used to identify risk factors and their relative contribution to impaired healing. RESULTS: Impaired healing of the perineal wound was observed in 10 (26%) of 38 patients. In four of them (11%) the wound remained nonhealed in 1 year after surgery. Preoperative radiotherapy, delayed primary closure of the wound and alcohol consumption in excess of 28 units/week was statistically significantly associated with impaired wound healing. Principal component analysis identified the following seven factors that cumulatively contributed to 96% of impaired healing: (i) distant metastases, (ii) preoperative radiotherapy, (iii) T-stage of the tumour, (iv) smoking, (v) perioperative blood transfusion, (vi) preoperative chemotherapy and (vii) development of side effects of preoperative chemoradiation. CONCLUSION: Patients who undergo APR of rectum are prone to impaired healing of the perineal wound if radiotherapy is used to treat malignancy prior to surgery and wound closure is delayed. In addition, the wound may not heal in patients with distant metastases, excessive alcohol consumption, present and past smokers and those who suffer adverse effects of preoperative chemoradiation and require blood transfusion.     

Local gentamicin application for perineal wound healing following abdominoperineal rectum excision

A major complication of abdominoperineal rectum excision for rectal or anal carcinoma is local wound infection. The main reason for this infection is that systemically administered antibiotic prophylaxis does not reach sufficiently high concentrations of antibiotic in the tissue of the sacroperineal wound. Since gentamicin-polymethylmethacrylate (PMMA) in the form of chains of beads has been confirmed as a useful tool in the treatment of local infection in bone and soft tissue surgery, we have evaluated its effect on the abdominoperineal rectum excision in a prospective, randomized trial. Forty-four patients with rectal or anal carcinoma entered the study. Only patients with stage Dukes D were excluded from the trial. Following randomized selection, the patients were treated either with local gentamicin and drainage (Group A) or drainage alone (Group B), using the Lloyd-Davies procedure. The two groups were comparable regarding age, sex, tumor stage and level, and risk factors predisposing for an infectious complication (anemia, nutritional status, blood transfusion). The postoperative mortality rate was 0% in both series. Analysis of local perineal wound healing revealed a statistically significant higher percentage of primary wound healing in Group A than in Group B (87% versus 46%; p less than 0.01). This led to a significantly shorter hospitalization period for patients in Group A (p less than 0.01). Gentamicin-PMMA chains have been demonstrated to exert a favorable effect on local wound healing and the postoperative outcome of patients with abdominoperineal rectum excision.     

Myocutaneous flap reconstruction of the perineum after radical abdominoperineal resection

Objective:  Wound dehiscence with nonhealing of the perineum is a significant morbidity associated with radical abdominoperineal resection (APR). Myocutaneous flaps have been used to facilitate primary wound healing. The purpose of this study is to evaluate the results of myocutaneous flap reconstruction of the perineum following radical APR.
Method:  The clinical records of patients who had myocutaneous flap reconstruction of the perineum between 2000 and 2005 were reviewed. Details of wound healing and complications related to the flaps were recorded.
Results:  Seventeen patients with a median age of 59 (range 29–77) years had primary reconstruction of the perineum with gracilis (10), rectus abdominis (6) and gluteal (1) myocutaneous flaps. Malignancy of the anus (12) and rectum (4) was the primary pathology and one patient had chronic perianal Crohn's fistulae. An 11 patients had preoperative radiotherapy in this group. Complete healing of the perineum was achieved in 16 (94.2%) of the 17 patients. There were 8 (47%) minor wound dehiscence and 2 (11%) skin necrosis all of which healed completely and 1 (5.8%) total flap necrosis.
Discussion:  Myocutaneous flaps improve wound healing with only minor morbidity in majority of patients and should be considered routinely to close perineal defects following radical APR particularly in irradiated perineum.     

腹腔镜辅助中位肛门闭锁成形术11例报告

目的 探讨腹腔镜辅助中位肛门闭锁成形术的可行性。方法 腹腔镜监视下,游离松解直肠;断离修补直肠尿道（阴道）瘘管,其中6例经腹腔镜离断修补,4例经会阴切口离断修补;然后在电刺激仪的引导下经会阴肌肉中心1.0cm左右小切口向盆底肌肉中心分离形成隧道,最后将直肠从隧道中拖出,与会阴皮肤吻合,同时关闭结肠造瘘口。结果 11例患儿均在腹腔镜辅助下完成肛门成形术,腹腔镜手术操作时间平均32.8min（25～78min）,出血量平均5.3ml（2～10ml）,无需要输血者。术后11d去除尿管或膀胱造瘘管,无尿道瘘或憩室出现,无切口感染发生。11例术后随访3～66个月,平均45个月。根据肛门功能临床评分标准评分（6分法）,排便优8例（72.7%）,良3例（27.3%）。结论 腹腔镜辅助中位肛门闭锁成形术处理直肠泌尿系瘘方便,辨认盆底肌中心准确及避免切口污染等优点,是治疗中位肛门闭锁有效方法。     

Complications of perineal artificial anus reconstruction after Mile's procedure and their management]

From 1987 to 1988, 122 patients with rectal carcinoma underwent Mile's procedure with their artificial anus reconstructed at the perineal region. In 59 patients (48.36%), complications occurred including wound infection on the perineum, mucosa prolapse of the artificial anus, anus retraction or severe edema, and perineal erosive dermatitis. The causes of the complications and the therapeutic approach were discussed.     

直肠癌Miles术后影响会阴部切口愈合的多因素分析

目的 对直肠癌行Miles手术可能影响会阴部切口愈合的多种因素进行分析,为合理处理各影响因素提供理论依据.方法 回顾性分析176例低位直肠癌行Miles手术的患者,采用SPSS For Windows 13.0统计分析,单因素分析用χ2检验或Fisher's确切概率法,将12个因素数量化后构建Logistic回归模型进行多因素分析,P＜0.05为差异有统计学意义.结果 直肠癌Miles术后会阴部切口一期愈合率为70.5%,29.5%的患者发生会阴部切口愈合不良.术前行放疗的患者会阴部切口一期愈合率与未行放疗者相比P=0.014,有统计学意义.Logistic回归分析显示:只有术前放疗的卡方值0.906＞0,P=0.012,OR为2.475.结论 直肠癌患者Miles手术前,行局部放疗的患者比未行放疗的患者更容易发生会阴部切口愈合不良,前者发生会阴切口愈合不良的危险是后者的2.475倍.