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[P10-6]腹会陰式直腸切断術後の骨盤内感染性合併症に対するVACシステムの有用性に関する検討

家城 英治1, 志村 匡信1, 川村 幹雄1, 山下 真司1, 今岡 裕基1, 北嶋 貴仁2, 奥川 喜永2, 大北 喜基1, 小林 美奈子3, 問山 裕二1 (1.三重大学医学部消化管・小児外科学, 2.三重大学医学部附属病院ゲノム医療部, 3.三重大学医学部先端的外科技術開発学)
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【Introduction】Pelvic surgical site infection (pSSI) still remains a major postoperative complication to overcome in patients who underwent abdominoperineal resection(APR). In this study, we investigated the effectiveness of negative pressure wound therapy (NPWT) including vacuum assisted closure (VAC) system to minimize pSSI after APR for ano-rectal diseases.【Method】This study includes patients who were performed APR from March 2015 to January 2025(n=68). The candidate patients are divided into two groups; Group1 (n=35): lower rectal cancer patients who underwent neoadjuvant chemoradiotherapy or total neoadjuvant therapy, and Group2 (n=33): patients with ano-rectal tumor or Crohn disease.【Results】In the total cohort consisting of 38 males and 30 females, we used VAC system for 48 patients, and other NPWT or none for 20 patients. While there was no statistical significance (P=0.12), the frequency of Grade3 (G3) pSSI was higher in Group1 (8cases, 22.9%) than in Group2 (3cases, 9.1%). Regarding the association between G3 pSSI and wound management, VAC patients showed significantly lower G3 pSSI (p=0.036). Furthermore, logistic regression univariate analysis in Group1 showed that non VAC patients were identified as significant risk factor for G3 pSSI (Odds ratio; 5.83, 95%C.I.; 1.12-36.07, p=0.036).【Conclusion】Our study indicates that VAC system might be useful to reduce severe pSSI in lower rectal cancer patients after multidisciplinary treatment.