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本文就115例腹会阴直肠切除术,对会阴伤口的两种不同处理方法进行分析比较.在年龄、性别、病理分期及恶性程度无明显差异的情况下,会阴伤口一期缝合组的平均愈合时间为16.90±4.35天,伤口敞开组为37.04±15.44天,差异显著(P<0.002).术后局部复发率分别为3/69例和2/46例,均为4.35%(P>0.05).一期缝合组的平均住院费用约为敞开组的46.87%～76.52%.作者指出,鉴于直肠癌逆行向下的淋巴扩散极为罕见,仅发生于高恶性或伴广泛淋巴转移的病例,因而对癌肿远端需切除2cm～3cm正常肠管而同时切除肛直肠环、不得不作手术者,会阴部清除范围无需太大,会阴伤口可分层完全缝合;对位于肛管内或侵及肛直肠环的癌肿,须彻底清除坐骨直肠窝脂肪结缔组织.本文两组术后局部复发率无差异,进一步表明这一认识的正确性.本组结果充分表明了会阴伤口一期缝合法的合理性与可行性.
This article analyzed 115 cases of perineal rectal resection and analyzed the two different treatment methods of perineal wounds. The average healing time of the perineal wounds in the first-phase suture group was not significantly different in age, gender, pathological stage, and malignancy. At 16.90±4.35 days, the wound open group was 37.04±15.44 days with significant difference (P<0.002). The postoperative local recurrence rates were 3/69 and 2/46 respectively, both being 4.35% (P>0.05). The average hospitalization cost for the primary suture group was approximately 46.87% to 76.52% of the open group. The authors pointed out that in view of the rare case of retrograde lymphatic spread of rectal cancer, which occurs only in cases of high-grade or extensive lymphatic metastases, the authors point out that Swollen distal end of the need to remove 2cm ~ 3cm normal intestine while removing the anorectal ring, had to be surgery, the perineum removal range does not need to be too large, the perineal wound can be completely layered suture; for the anal canal or invasion of the anorectal ring Cancer, must remove the fat connective tissue in the rectocele of the ischium. There is no difference in the local recurrence rate between the two groups after surgery, which further demonstrates the correctness of this understanding. This group of results fully demonstrates the rationality and feasibility of the first-phase perineal wound suture method. Sex.