四种腹部切口减张缝合方式的比较

A comparative study on four methods of tension suture of abdominal incision

目的:探讨腹部切口减张缝合的理想方式。方法:归纳经腹直肌切口及腹正中切口并行切口减张缝合的病例共161例,缝合方式为四种:A.传统全层间断减张缝合法;B.全层间断水平褥式(U形)减张缝合法;C.抗菌微乔线间断埋藏式内减张缝合法+丝线常规分层缝合关腹;D.抗菌微乔线间断埋藏式内减张缝合法+抗菌微乔线常规分层缝合筋膜关腹。按切口裂开率、甲级愈合率进行对比分析。结果:D组甲级愈合率优于前A组及D组,P<0.05。D组与B组在甲级愈合率方面的差异无统计学意义,B组出现1例较严重的皮肤及软组织坏死;B组甲级愈合率优于A组,P<0.05;C组+D组的甲级愈合率高于A组+B组。各组在切口裂开率方面差异无统计学意义。结论:全层间断水平褥式减张缝合法切口并发症出现率低于传统全层间断减张缝合,但需注意缝合间距及张力,避免局部组织坏死。抗菌微乔埋藏式内减张缝合法切口并发症出现率低,并且免除了术后拆除减张线的工作步骤;切口全应用抗菌微乔线关腹法(除皮肤外)进一步减少了线头反应、慢性窦道形成的几率,值得推广应用。

Objective： To explore the ideal tension suture for abdominal incision.Methods：Summarized the 161 cases with tension suture on abdominal rectus incision or median incision.Four types of tension suture were categorized： A.The traditional full-thickness intermittent tension suture method;B.The full-thickness intermittent horizontal mattress（U-shaped） tension suture method;C.Buried tension suture with Coated VICRYL Plus Antibacterial suture ＋ Conventional layered suture with virgin silk;D.Buried tension suture with Coated VICRYL Plus Antibacterial suture ＋ layered fascia suture with Coated VICRYL Plus Antibacterial suture.The healing rate of class A and the rate of incision disruption were assessed.Results：The healing rate of class A of group D was higher than group A and group C（P0.05）.There was no statistical difference between group D and group B,however there was 1 case reporting quite serious necrosis of skin and soft tissue.The healing rate of class A of group B was higher than group A（P0.05）.The healing rate of class A of group C＋D was higher than group A＋B（P0.05）.There was no significant difference regarding the rate of incision disruption between each group.Conclusion：The full-thickness intermittent horizontal mattress（U-shaped） tension suture method involved less incidences of incision complications,compared to the traditional full-thickness intermittent tension suture method,however effort should be paid to maintain appropriate suture intervals and tension,to avoid local tissue necrosis.Buried tension suture with Coated VICRYL Plus Antibacterial suture involved minimum incision complications,and saved the post-surgical procedures of removing stitches.The thorough application of abdominal suture（except skin） with Coated VICRYL Plus Antibacterial suture further was worth promotion,which can reduce the incidences of thread-end reaction,and the chronic formation of sinus.