两种不同切口缝合法在化脓性或坏疽性阑尾切除术中的随机对照研究

Randomized Controlled Trial of Two Different Incision Suture Techniques in Appendectomy for Suppurative or Gangrenous Appendicitis

目的比较不同切口缝合法在化脓性或坏疽性阑尾切除术中的临床应用效果。方法2004年8月-2006年12月对613例采用右下腹切口行化脓或坏疽性阑尾切除术病人,随机分为采用腹膜外单层缝合（单层缝合组259例）或常规切口分层缝合（分层缝合组354例）,对其疗效进行对比分析。结果单层缝合组在手术时间、术后7 d内出院率、切口感染率等方面明显低于分层缝合组（P〈0.01）;两组术后24 h下床活动者及镇痛药物应用比较无显著性差异（P〉0.05）;术后210例平均随访17个月,两组在术后粘连性肠梗阻、切口疝等方面比较差异无显著性（P〉0.05）。结论对化脓性或坏疽性阑尾炎开腹阑尾切除术,右下腹横切口腹膜外单层缝合法具有操作简单、安全、并发症少的优点,值得推广。

Objective To compare the effect of two different down-right abdominal incision sutures in open suppurative or gangrenous appendectomy, Methods 613 suppurative or gangrenous appendicitis patients underwent open appendectomy by down-right abdominal incision during Aug. 2004- Dec. 2006 were randomized into two groups ： Group A （ n = 259） was stitched the incision by single layer extraperitoneal suture and group B （n = 354） by layered closure technique. The effect was compared between two groups. Results The operation duration, hospital discharge rate within 7 days postoperatively and incision infection rate of group A were less than that of group B （P 〈0.01 ）. Whereas, there was no significant difference in the rates of 24- hour- off-bed activity and analgesic agents application between two groups （P 〉 0.05 ）. 210 cases were followed up for average 17 months. The incidences of adhesive intestinal obstruction and incision hernia were no difference between group A and group B （P 〉 0.05）. Conclusion Single layer extraperitoneal suture is a simple and safe closure technique with less complication for down-right abdominal incision in appendectomy for suppurative or gangrenous appendicitis, and deserved to popularize.