改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

doi:10.3969/j.issn.1009-976X.2022.04.004

岭南现代临床外科 ›› 2022, Vol. 22 ›› Issue (04): 336-339.DOI: 10.3969/j.issn.1009-976X.2022.04.004

改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

张垒, 胡静, 晁娟, 肖志强, 苗同林, 单长岭^*

山东省济宁医学院附属金乡医院胃肠外科,山东济宁 272200

通讯作者: *单长岭,Email：jinniu.521@163.com.

Application effects of modified gunsight technique closure of the wound following protective ileostomy reversal

ZHANG Lei, HU Jing, CHAO Juan, XIAO Zhi-qiang, MIAO Tong-lin, SHAN Chang-ling

Department General Surgery, the Affiliated Jinxiang's Hospital of Jining Medical College, Jining, Shandong 272200, China

Received:2022-03-25 Online:2022-08-20 Published:2022-09-22
Contact: SHAN Chang-ling, jinniu.521@163.com

摘要/Abstract

摘要： 目的探讨改良“瞄准器”状缝合术处理回肠造口还纳术后腹壁切口的应用效果。方法回顾性分析2019年2月至2022年2月间笔者团队收治的58例回肠造口还纳术患者病例资料,根据造口还纳术后腹壁切口缝合方式的不同,将研究对象分为观察组（26例）及对照组（32例）,观察组采用改良“瞄准器”状缝合术,对照组采用传统一期缝合术。比较两组患者的手术时间、术中出血量、术后进食时间、拆线时间、术后住院时间、切口感染率及术后切口疼痛评分。结果观察组术后进食时间、拆线时间、术后住院时间、术后第一天疼痛评分及切口感染率明显低于对照组（均P < 0.05）。两组手术时间、术中出血量差异比较未见统计学意义（均P > 0.05）。结论与传统一期缝合术相比,改良“瞄准器”状缝合术处理腹壁切口可明显降低回肠造口术后切口感染率及术后第一天疼痛感,缩短术后进食时间、拆线时间及术后住院时间。

关键词: 改良瞄准器状缝合术, 回肠造口, 回肠还纳

Abstract: Objective To explore the application effects of modified gunsight skin incision and suture technique in the treatment of ileostomy closure after abdominal wall incision. Methods Fifty-eight patients of ileostomy from February 2019 to February 2022 in our hospital were also retrospectively analyzed, the subjects were divided into observation group（n=26） and control group（n=32）. The patients in the observation group were treated with modified gunsight technique while the control group with traditional primary suture. The operative time, intraoperative blood loss, postoperative diet time, stitches removing time, postoperative hospital stay,wound infection rate and postoperative pain score were compared between the two groups. Results The postoperative diet time,stitches removing time,postoperative hospital stay,wound infection rate and pain score on the first postoperative day of the observation group were significantly lower than those of the control group（all P values< 0.05）. There were no significant difference in the operative time and intraoperative blood loss between the two groups（all P values >0.05）. Conclusion Compared with the traditional primary suture, the modified gunsight technique can effectively reduce postoperative diet time, stitches removing time, postoperative hospital stay, wound infection and pain on the first postoperative day.

Key words: modified gunsight technique, ileostomy, ileostomy reversal

中图分类号:

R608
R656.7

张垒, 胡静, 晁娟, 肖志强, 苗同林, 单长岭. 改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用[J]. 岭南现代临床外科, 2022, 22(04): 336-339.

ZHANG Lei, HU Jing, CHAO Juan, XIAO Zhi-qiang, MIAO Tong-lin, SHAN Chang-ling. Application effects of modified gunsight technique closure of the wound following protective ileostomy reversal[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 336-339.

参考文献

[1] Hsieh MC, Kuo LT, Chi CC, et al.Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate:a meta-analysis of randomized controlled trials[J]. Dis Colon Rectum,2015, 58(8):808-815.
[2] Banerjee A.Pursestring skin closure after stoma reversal[J]. Dis Colon Rectum, 1997, 40(8):993-994.
[3] Lin H, LI W.Complete closure using a double purse-string closure for skin defects[J]. Dermatol Surg, 2010, 35(9):1406-1409.
[4] Lim JT,Shedda SM,Hsyes IP.‘Gunsight’ skin incision and closure technique for stoma reversal[J]. Dis Colon Rectum,2010,53(3):1569-1575.
[5] 谢忠士,李春生,房学东.皮肤荷包缝合法在回肠造口还纳术中的应用[J].中华胃肠外科杂志,2018,21(3):354-355.
[6] Ban KA, Minei JP, Laronga C, et al.American College of Surgeons and Surgical Infection Society:Surgical Site Infection Guidelines, 2016 Update[J]. J Am Coll Surg, 2017, 22(1):59-74.
[7] 韩加刚,周建平,王贵英,等. 十字缝合和荷包缝合技术用于肠造口还纳手术皮肤关闭的多中心随机对照研究[J].中华外科杂志,2020,58(8):608-613.
[8] 黄兴华,彭翔宇,郭煜扬,等. 皮下全程持续负压引流行肝癌手术切口缝合75例报告[J].中国实用外科杂志,2021,41(10):1176-1177.
[9] 陈双,杨斌. 外科缝合材料进展与选择缝线的原则[J]. 中国实用外科杂志, 2005,25(8):511-512.
[10] 陶琦,邓黎,张东平,等. “瞄准器”状皮肤切开缝合法与传统一期缝合法处理肠造口还纳术后腹壁切口的疗效对比[J]. 结直肠肛门外科,2017,23(4):490-494.
[11] Li CK, Liang WW, Wang HM, et al.Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures[J]. Gastroenterol Rep, 2020,9(4):357-362.
[12] 韩加刚,周建平,王贵英, 等. 十字缝合和荷包缝合技术用于肠造口还纳手术皮肤关闭的多中心随机对照研究[J]. 中华外科杂志, 2020, 58(8):608-613.
[13] 刘晓亮. 结直肠癌术后表浅手术切口感染的影响因素分析[J].广西医科大学学报,2018,35(1):65-67.
[14] 赵玉沛. 普通外科缝合技术和缝线的发展历史现状和展望[J].中国实用外科杂志,2008,28(10):789-792.
[15] Pan HD, Wang L,Peng YF, et al.Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy[J]. Int J Colorectal Dis, 2015,30:977-982.
[16] 牛冬光,周沛红,郭星莹,等. 临时性肠造口还纳145例切口感染防治经验[J]. 青岛大学医学院学报,2016,52(6):718-720.
[17] 魏广辉,高志刚,杨勇,等. 封闭式造口肠段切除法在预防性肠造口还纳术中的临床应用[J].中华胃肠外科杂志,2012,15(4):446.

改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

Application effects of modified gunsight technique closure of the wound following protective ileostomy reversal

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