中文摘要：

目的观察直肠癌低位前切除保护性回肠造口还纳术后并发症发生情况，并探讨术后切口感染的危险因素。方法回顾性分析2006年9月至2013年3月间于北京肿瘤医院接受保护性回肠造口还纳术的245例低位直肠癌患者的临床病理资料。观察患者术后相关并发症的发生情况。并对可能影响术后切口感染的临床病理特征进行单因素和多因素分析。结果造口还纳术后有33例（13．5％）患者出现了并发症，其中手术切口感染21例（8．6％），肠梗阻8例（3．3％），吻合口瘘或直肠阴道瘘5例（2．0％），肺部感染2例（0．8％，其中1例合并败血症），肛门括约肌功能障碍2例（0．8％）。全组无围手术期死亡病例，但有5例（2．0％）患者接受了二次手术治疗，包括肠梗阻3例及直肠阴道瘘和吻合口瘘各1例。术后并发症（OR=10．576，95％CI：2．898—38．597，P=0．000）及手术时间大于90min（OR=4．862，95％CI：1．758～13．451，P=0．002）是切口感染的独立危险因素；而皮下引流（OR=0．063，95％CI：0．007—0．540，P=0．012）是切口感染的独立保护因素。结论切口感染是保护性回肠造口还纳术后最为常见的并发症。皮下负压引流是降低切口感染率的有效手段；对于手术时间超过90min的患者，推荐行皮下负压引流。

英文摘要：

Objective To analyze the complications of ileostomy closure and related risk factors. Methods Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital from September 2006 to March 2013 were included in this study. Clinical features of these patients were reviewed, the complications rate was calculated, and univariate and multivariate analyses with regard to the risk factors of surgical site infection （SSI） were also conducted. Results A total of 245 consecutive patients were enroUed in the study. Thirty-nine complications were observed in thirty-three patients, the overall complication rate was 13.5%. Complication after primary closure of defunctioning ileostomy included surgical site infection （n=21, 8.6%）, ileus （n=8, 3.3%）, preoperatively undiagnosed anastomotic leakage or rectovaginal fistula（n=5, 2.0%）, pulmonary infection （n=2, 0.8%）, and anal sphincter dysfunction （n=2, 0.8%）. No patient died in the perioperative period, and 5 patients （2.0%） underwent reoperation for ileus （n=3）, anastomotic leakage （n=1） and rectovaginal fistula （n=l）. Multivariate analysis showed that postoperative complications [0R=10.576, 95%CI：2.898-38.597, P=0.000] and total operation time 〉90 min [0R=4.862, 95% CI： 1.758-13.451, P=0.002] were independent risk factors of SSI, and the presence of subcutaneous vacuum drainage [OR=0.063, 95%CI：0.007-0.540, P=0.012] was protective factor of SSI. Conclusions Surgical site infection is the most common complication after primary closure of defunctioning ileostomy. Subcutaneous vacuum drainage is effective for reducing SSI in patients undergoing primary closure of ileostomy, and it is especially recommended for patients with operation time 〉90 min.