肛管持续冲洗+负压引流在预防低位直肠癌术后吻合口瘘中的应用研究
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摘要
目的:肛管持续冲洗+负压引流在预防低位直肠癌术后吻合口瘘中的应用研究。方法:选取2015年7月-2018年3月本院经肠镜取病理确诊为低位直肠癌且行Dixon手术治疗的患者56例,按照随机数字表法分为研究组与对照组,各28例。研究组术后采用肛管持续冲洗+负压引流的方法进行处置,对照组术后采用肛管引流的方法进行处置。比较两组手术时间、术中出血量、术后首次排气时间、住院时间、住院费用、术后感染及吻合口瘘发生率。结果:两组手术时间、术中出血量、术后首次排气时间、住院时间和住院费用比较,差异均无统计学意义(P>0.05)。研究组术后感染率、出现吻合口瘘率均明显低于对照组,差异均有统计学意义(P<0.05)。结论:肛管持续冲洗+负压引流能够有效地预防低位直肠癌术后吻合口瘘的发生。
Objective:To explore the application of continuous anal irrigation and negative pressure drainage in preventing anastomotic leak after low rectal cancer operation.Method:A total of 56 cases were diagnosed low rectal cancer and operated by Dixon surgery in our hospital from July 2015 to March 2018,they were divided into experimental group and control group according to table of random numbers,28 cases in each group.The experimental group was given continuous anal irrigation and negative pressure drainage after operation,the control group was received anal canal drainage.The operation time,intraoperative blood loss,postoperative first exhaust time,hospitalization time,hospitalization expenses,the incidence rate of postoperative infection and anastomotic leak of two groups were compared.Result:There were no significant difference in the operative time,intraoperative blood loss,postoperative first exhaust time,hospitalization time and hospitalization expenses between two groups(P>0.05).The incidence rate of postoperative infection and anastomotic leak in the experimental group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:The continuous anal irrigation and negative pressure drainage can effectively prevent the occurrence of anastomotic leak after low rectal cancer operation.
Objective:To explore the application of continuous anal irrigation and negative pressure drainage in preventing anastomotic leak after low rectal cancer operation.Method:A total of 56 cases were diagnosed low rectal cancer and operated by Dixon surgery in our hospital from July 2015 to March 2018,they were divided into experimental group and control group according to table of random numbers,28 cases in each group.The experimental group was given continuous anal irrigation and negative pressure drainage after operation,the control group was received anal canal drainage.The operation time,intraoperative blood loss,postoperative first exhaust time,hospitalization time,hospitalization expenses,the incidence rate of postoperative infection and anastomotic leak of two groups were compared.Result:There were no significant difference in the operative time,intraoperative blood loss,postoperative first exhaust time,hospitalization time and hospitalization expenses between two groups(P>0.05).The incidence rate of postoperative infection and anastomotic leak in the experimental group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:The continuous anal irrigation and negative pressure drainage can effectively prevent the occurrence of anastomotic leak after low rectal cancer operation.
引文
[1]贾会文,宋展,王文胜,等.负压封闭引流术在预防直肠癌患者手术切口感染的临床分析[J].中华医院感染学杂志,2016,26(4):867-869.
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[8]余加和,黄项武,董志勇,等.自制双套管持续冲洗治疗腹腔镜低位直肠癌根治术后吻合口瘘[J].河南医科大学学报,2015,36(4):408-411.
[9]李世邦,刘牧林,孔玲尚,等.我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析[J/OL].中华普通外科学文献:电子版,2013,7(3):52-56.
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[11]李伟冬,贾林.结直肠癌的社区筛查及早期诊治[J/OL].中华临床医师杂志(电子版),2015,9(5):13-15.
[12]夏扣柱,张健.自制双套管持续负压吸引在直肠癌术中的应用[J].中国普外基础与临床杂志,2014,21(3):367-369.
[13]覃团宏.低位直肠癌保肛根治术后吻合口瘘防治体会[J].湖北科技学院学报(医学版),2014,28(1):41-42.
[14]羊涛,张嘉越,冷津立,等.肠腔内外双套管负压引流在左半结肠穿孔行一期修补术中的应用[J].中华普通外科杂志,2014,29(11):872-873.
[15]王维新,成德文,祁卫东.预置改良双套管治疗贲门癌、直肠癌术后吻合口漏的临床研究[J].医学理论与实践,2013,26(24):3270-3271.
[16]张嘉越,黄永鸿,庞飞雄,等.肠腔内外双套管负压引流在左半结肠癌并急性梗阻一期切除吻合中的应用[J].中国普外基础与临床杂志,2015,22(3):307-311.
[17]欧明明,韩培彦,黄晓峰.一次性闭合高负压引流瓶在根治性颈淋巴结清扫术后应用的研究[J].临床和实验医学杂志,2017,16(12):1232-1234.
[18]李文霞,刘丹,黄淑俊.真空高负压引流与潘氏管双管引流在乳腺癌手术中的应用效果[J].中国医药导报,2015,12(35):99-102.
[19]肖雄升,谢洪泼,税晓容,等.一次性闭合高负压引流系统配合中药在乳腺癌手术患者中的临床应用[J].中国医药导报,2016,13(17):109-112.
[20]常世民,王贝贝,张方明.Drainobag高负压引流瓶和普通负压引流瓶在104例腮腺浅叶切除手术中应用的对比观察[J].中华老年口腔医学杂志,2014,12(4):215-218.
[2]黄钰.负压封闭引流术在预防糖尿病直肠癌患者手术切口感染的临床分析[J].大家健康(下旬版),2017,11(4):92-93.
[3]江小好,曾冰川,刘国珍.腹腔镜保肛术治疗低位直肠癌的围手术期护理观察[J].临床医学工程,2015,22(6):795-796.
[4]Sverrisson I,Nikberg M,Chabok A,et al.Hartmann’s procedure in rectal cancer:a population-based study of postoperative complications[J].Int J Colorectal Dis,2015,30(2):181-186.
[5]Steinemann D C,Stierle T,Zerz A,et al.Hartmann’s procedure and laparoscopic reversal versus primary anastomosis and ileostomy closure for left colonic perforation[J].Langenbecks Arch Surg,2015,400(5):609-616.
[6]Zhang J Y,Huang Y H,Pang F X,et al.Application of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction[J].Chin J Bases Clin General Surg,2015,22(3):307-311.
[7]刘剑,张贵阳,郑照正.结直肠肿瘤患者术后感染的危险因素分析[J].中华医院感染学杂志,2014,24(3):693-694,697.
[8]余加和,黄项武,董志勇,等.自制双套管持续冲洗治疗腹腔镜低位直肠癌根治术后吻合口瘘[J].河南医科大学学报,2015,36(4):408-411.
[9]李世邦,刘牧林,孔玲尚,等.我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析[J/OL].中华普通外科学文献:电子版,2013,7(3):52-56.
[10]田少林,高友兵.经肛门吻合口漏引流治疗直肠癌保肛术后吻合口漏临床疗效观察[J].中国实用外科杂志,2015,35(5):549-551,554.
[11]李伟冬,贾林.结直肠癌的社区筛查及早期诊治[J/OL].中华临床医师杂志(电子版),2015,9(5):13-15.
[12]夏扣柱,张健.自制双套管持续负压吸引在直肠癌术中的应用[J].中国普外基础与临床杂志,2014,21(3):367-369.
[13]覃团宏.低位直肠癌保肛根治术后吻合口瘘防治体会[J].湖北科技学院学报(医学版),2014,28(1):41-42.
[14]羊涛,张嘉越,冷津立,等.肠腔内外双套管负压引流在左半结肠穿孔行一期修补术中的应用[J].中华普通外科杂志,2014,29(11):872-873.
[15]王维新,成德文,祁卫东.预置改良双套管治疗贲门癌、直肠癌术后吻合口漏的临床研究[J].医学理论与实践,2013,26(24):3270-3271.
[16]张嘉越,黄永鸿,庞飞雄,等.肠腔内外双套管负压引流在左半结肠癌并急性梗阻一期切除吻合中的应用[J].中国普外基础与临床杂志,2015,22(3):307-311.
[17]欧明明,韩培彦,黄晓峰.一次性闭合高负压引流瓶在根治性颈淋巴结清扫术后应用的研究[J].临床和实验医学杂志,2017,16(12):1232-1234.
[18]李文霞,刘丹,黄淑俊.真空高负压引流与潘氏管双管引流在乳腺癌手术中的应用效果[J].中国医药导报,2015,12(35):99-102.
[19]肖雄升,谢洪泼,税晓容,等.一次性闭合高负压引流系统配合中药在乳腺癌手术患者中的临床应用[J].中国医药导报,2016,13(17):109-112.
[20]常世民,王贝贝,张方明.Drainobag高负压引流瓶和普通负压引流瓶在104例腮腺浅叶切除手术中应用的对比观察[J].中华老年口腔医学杂志,2014,12(4):215-218.