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目的探讨直肠癌腹会阴联合切除术 (Miles)中应用高频电刀对会阴切口愈合的影响及对策。方法将Miles术患者分为 4组 :A组 5 5例 ,会阴部以解剖刀操作 ;BⅠ组 5 5例 ,会阴部以高频电刀操作 ;BⅡ组 30例 ,会阴部以高频电刀操作 +术中大网膜填塞骶前残腔 ;BⅢ组 5 5例 ,会阴部以高频电刀操作 +术后会阴部电磁波照射 ,每次 6 0min ,1次 /日 ,连续照射 10d。比较各组骶前引流总量、引流时间、骶前感染率、会阴切口裂开率、术后住院天数及医疗费用的情况。结果A、BⅠ两组间差异有非常显著意义 (P <0 0 1,<0 0 1,<0 0 5 ,<0 0 5 ,<0 0 1,<0 0 1) ,A组优于BⅠ组 ;BⅠ、BⅡ两组间除骶前引流总量差异无显著意义 (P >0 5 )外 ,其他各项差异均有非常显著意义 (P <0 0 1,<0 0 5 ,<0 0 5 ,<0 0 1,<0 0 1) ,BⅡ组优于BⅠ组 ;BⅡ、BⅢ组间差异无显著意义 (P >0 5 0 ,>0 10 ,>0 5 0 ,>0 2 5 ,>0 0 5 ,>0 5 0 )。结论高频电刀的应用严重影响会阴切口的愈合 ,术中大网膜骶前填塞或术后会阴部电磁波照射是消除或降低高频电刀有害影响的有效措施。会阴部电磁波照射具有方便、安全、实用等优点 ,因此有临床应用价值
Objective To investigate the effect of high frequency electric knife on the healing of perineal incision in rectal cancer perineum combined with excision (Miles) and its countermeasures. Methods Miles patients were divided into 4 groups: A group of 55 cases, perineal operation with a scalpel; B Ⅰ group of 55 cases perineal operation with high frequency electric knife; B Ⅱ group of 30 cases, perineal Department of high frequency electric knife Operation + intraoperative omentum obliteration presacral remnants; B Ⅲ group of 55 cases perineal Department of high frequency electric knife operation + perineal electromagnetic wave irradiation, each 6 0min, 1 time / day, continuous irradiation 10d. The total presacral drainage volume, drainage time, presacral infection rate, perineal incision rate, postoperative hospitalization days and medical expenses were compared between groups. Results There was significant difference between the two groups (P <0.01, <0.01, <0.05, <0.05, <0.01, <0.01) (P <0 01, <0 0 5, <0 0) except for the total presacral drainage volume between BⅠ and BⅡ groups (P> 0.05) 5, <0 0 1, <0 0 1). The BⅡgroup was superior to the BⅠgroup. There was no significant difference between the BⅡ and BⅢgroups (P> 0.05,> 0 10,> 0 05,> 0 2 5, > 0 0 5,> 0 0 0). Conclusion The application of high-frequency electric knife seriously affects the healing of perineal incision. Intraoperative omentum sacral pre-shunt or perineal electromagnetic wave irradiation is an effective measure to eliminate or reduce the harmful effects of high-frequency electric knife. Perineal electromagnetic radiation has the advantages of convenience, safety and practicality, so it has clinical value