腹腔镜Miles术后双引流法防治会阴切口感染

目的 研究经右麦氏点和会阴切口中间骶前尾骨双引流法,在腹腔镜腹会阴联合切除术(Miles)术后会阴切口感染防治中的作用.方法 将98例直肠癌行腹腔镜Miles手术患者随机分为两组,A组51例,会阴切口缝合后,行经右麦氏点合并经会阴切口中间骶前尾骨引流；B组47例,会阴切口缝合后,引流管经会阴切口中间引出；若术后有发生会阴切口感染情况,A组需拔除经会阴切口中间引流管并行切口部分开放换药外,并保留经右麦氏点引流管进行冲洗；B组拔除经会阴切口中间引流管并行切口部分开放换药.结果 A组会阴切口感染率为17.6％,与B组的19.1％比较,差异无统计学意义；切口感染后,A组换药平均时间为(26.8±4.9)d；B组换药平均时间为(43.1±5.4)d,A组明显短于B组.结论 腹腔镜Miles术后联合经右麦氏点和经会阴切口中间骶前引流有利于盆腔创面的愈合；一旦会阴切口发生感染,拔除经会阴切口旁引流管,保持经右麦氏点骶前引流管进行主动引流,可加快会阴切口的愈合.

Dual drainage on prevention of perineal incision infections after laparoscopic Miles

OBJECTIVE To study the effect of right McBurney point and perineal incision anterior sacral coccyx middle double drainage applied in laparoscopic Miles on the prevention of perineal incision infections.METHODS A total of 98 cases of patients with rectal cancer who underwent laparoscopic Miles were randomly divided into group A(51 cases),who underwent right McBurney point combined with perineal incision anterior sacral coccyx after the suture of perineal incision,and group B(47 cases),who underwent intermediate extraction of drainage tube after the suture of perineal incision;if the postoperative perineal incision infection occurred,the drainage tube of group A was necessary to be pulled out after the suture of perineal incision with middle portion of the opening and retained by dressing as well as right McBurney point drainage tube for washing,the drainage tubes except the those parallel to middle portion of the incision of group B were extracted with the opening dressing retained.RESULTS The perineal incision infection rate in group A was 17.6%,as compared with 19.1% in group B,the difference was not statistically significant;the average time of dressing after the occurrence of incision infection in group A was(26.8±4.9)d,significantly shorter than(43.1±5.4)d of group B.CONCLUSION The laparoscopic Miles in combination with right McBurney point and perineal incision intermediate presacral drainage may facilitates the healing of pelvic wound;once the perineal incision infection occurs,to remove the perineal incision drainage tube and keep the right McBurney point presacral drainage tube active for the drainage can accelerate the healing of perineal incision.