临床外科杂志 ›› 2020, Vol. 28 ›› Issue (1): 63-65.doi: 10.3969/j.issn.1005-6483.2020.01.019

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十字缝合技术用于肠造口还纳手术的临床分析

  

  1. 100020 首都医科大学附属北京朝阳医院普通外科
  • 出版日期:2020-01-20 发布日期:2020-01-20
  • 通讯作者: 王振军,Email:drzhenjun@163.com
  • 基金资助:
    国家自然科学基金资助项目(81541101);首都临床特色应用研究资助项目(Z121107001012131);首都卫生发展科研专项资助项目(首发2018-1-2032、2014-4-2033);北京朝阳医院1351人才培养计划资助项目(CYXZ-2017-09);北京市属医院科研培育资助项目(PX2019012)

Prelimary outcomes following gunsight technique closure of the wound following loop stoma reversal

  1. Department of General Surgery,Beijing Chaoyang Hosptial,Capital Medical University,Beijing 100020,China
  • Online:2020-01-20 Published:2020-01-20

摘要: 目的 总结十字缝合技术在肠造口还纳手术中的应用体会。方法 接受双腔造口还纳手术22例,采用十字缝合技术。距离造口边缘0.2cm横行连续缝合皮肤,关闭造口;游离肠管,行肠吻合后,肠管还纳入腹腔,连续缝合腹直肌鞘;可吸收缝线环形缝合皮下脂肪组织,打结时保留1cm孔隙;标记0、3、6、9点4个位点,将4个位点造口边缘皮肤提拉到造口中心,在提拉后的皮肤上标记提拉前皮肤边缘的所处位置,三角形切除标记点到造口边缘的皮肤,可吸收缝线缝合皮肤边缘4个点的皮下组织,收紧打结,中央保留0.5cm小孔,放置引流条。2-0可吸收缝线间断缝合切口。结果 平均术中失血量20ml(10~40ml),平均手术时间70分钟(60~90分钟),平均术后住院时间6.5天(5~8天)。22例病人中,仅1例术后第2天发生切口感染,感染率4.5%。切口愈合平均时间17天(14~22天)。术后平均随访14个月(10~21个月),病人对切口美容效果平均满意度9分(6~10分)。结论 十字缝合技术能够降低切口张力,缩短切口愈合和住院时间,术后美容效果满意,不增加手术时间和术后疼痛,可安全、有效用于肠造口还纳。

关键词: 肠造口, 造口还纳, 十字缝合技术, 切口感染, 愈合时间

Abstract: Objective To summarize the experience of gunsight closure technique in loop stoma reversal.Methods This retrospective trial enrolled 22 patients who underwent gunsight stoma closure.The main techniques were as followings:The skin was sewn continuously 0.2cm away from the edge of the stoma to close the stoma.After intestinal anastomosis,the intestine was incorporated into the abdominal cavity and the fascial closure was achieved en masse continuously with PDS II.The subcutaneous adipose tissue was sutured by circular absorbable suture and leaving a residual hole of 1cm in the center.Grasped the skin and pulled it toward the center of the wound to mark four points and triangles of 0,3,6,and 9 o’clock.Resected the four triangles and placed a circumferential absorbable subcuticular suture in the wound edge,leaving a small residual hole of 0.5cm in the center of the wound,leaving a drainage strip in the hole.Interrupted sutured the wound.Results The median blood loss was 20ml(10~40ml),median operative time was 70min(60~90min),median postoperative hospital stay was 6.5 days(5~8 days).There was only one patient(4.5%)with surgical site infection on the second day postoperatively.The median healing time was 17 days(14~22 days).The median cosmetic score according to the visual analog scale(0 being the lowest and 10 the highest grade in cosmetic scar perception of the patient)was 9(6~10)with a median followup of 14 months(10~21 months).Conclusion Gunsight closure might be a relatively safe and feasible technique for stoma reversal,and might lower the wound tension,shorter wound healing time and postoperative hospital stay with satisfied cosmetic results,without prolonged operative time and increased postoperative pain.

Key words: stoma, stoma reversal, gunsight closure, surgical site infection, wound healing time

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