腹部正中切口两层缝合法与传统四层缝合法的临床随机对照研究

Two-layer Suturing versus Four-layer Suturing in Abdominal Median Incision:A Randomized Controlled Trial

目的探讨腹部正中切口两层缝合法的临床效果及与传统切口四层缝合法的区别。方法采用随机对照试验方法,将2008年1月～2008年4月期间符合纳入标准的124例患者分为两组,试验组61例,采用两层缝合法,对照组63例,采用四层缝合法。比较两组患者术前基本情况、手术切口相关指标及术后全身/切口恢复指标的差异。结果术前两组患者基线情况一致。术后两组患者在住院时间、下床活动时间、术后进食时间及术后经肛门排气时间上,其差异均无统计学意义(P>0.05);但在术后患者出现发热症状的构成比上,试验组明显低于对照组,其差异有统计学意义(P=0.014)。两组术后切口愈合级别以甲级愈合为主,其差异无统计学意义(P>0.05)。从术后切口并发症角度看,两组均无切口感染、切口异物肉芽肿形成和窦道形成,但对照组分别有切口活动性出血3例和切口裂开2例,试验组均为0例;此外,试验组出现切口液化的构成比也明显少于对照组,其差异有统计学意义(P=0.003)。结论就腹部正中切口而言,两层缝合法较传统四层缝合法可能会为患者带来更小的切口创伤,更少的切口异物刺激以及合理的解剖结构复位,从而具有更佳的临床效果和安全性。但两层缝合法是否还适用于其它类型伤口尚需进一步研究。

Objective To investigate the effect of a new suturing method called two-layer closure and to compare this with the traditional four-layer suturing method. Methods A randomized controlled trial was conducted in patients admitted from January to April 2008. A total of 124 eligible patients were divided into 2 groups. Sixty-one patients in the trial group received two-layer closure, while 63 in the control group received four-layer closure. The baseline conditions before the operation, incision parameters, and the recovery of the body and incision after the operation were compared between the 2 treatment groups. Results The baseline characteristics of the groups were similar. No significant differences were observed in terms of the length of hospital stay, time to food intake, time to ground activity, and time to first passage of gas by anus （P〉0.05）. However, the incidence of fever after the operation was significantly lower in the trial group compared with the control group （P=0.014）. The healing level of the incisions was comparable between the 2 groups （P〉0.05）. As for complications after the operation, no cases of incision infection or incision granuloma or sinus tract were reported. However, 3 cases of active hemorrhage and 2 cases of incision split occurred in the control group. Moreover, the incidence of incision liquefaction in the trial group was significantly lower than that in the control group （P=0.03）. Conclusion For abdominal median incision, two-layer closure is associated with smaller incision trauma, less stimulation from extraneous materials, as well as more accurate anatomic replacement compared with the traditional four-layer closure. However, further studies need to be conducted to determine whether the new suturing method of two- layer closure is effective and safe for other kinds of incision.