连续经肌全层关腹技术在腹部外科的应用

Continuous mass closure to abdominal incision using MPS suture

目的探讨MPS线在腹壁切口全层连续缝合中的应用。方法自2006年1月至2010年5月对443例腹部手术切口大于20cm的病人分别采取3种不同的缝合方法。病人分普通组360例，其中MPS缝合19l例，常规逐层缝合169例；需减张缝合组83例，其中MPS缝合51例，减张缝合32例。并对术后随访1个月至1年，并对各种手术切口并发症、关腹时间收集数据并用统计学处理。结果普通组中MPS缝合：术中缝合无撕裂腹膜现象，无伤口裂开、粘连性肠梗阻、切口疝等并发症；伤口局部皮下脂肪液化、积液或感染3例；两种缝合方式之间伤口裂开、粘连性肠梗阻和局部皮下积液或感染差异有统计学意义（P〈0．05）。需减张缝合组中减张缝合病例术中缝合撕裂腹膜18例，伤口裂开2例，无粘连性肠梗阻、伤口皮下脂肪液化、积液或感染及切口疝等；而MPS缝合无以上并发症。结论MPS线连续经肌全层关腹技术方法简单，易掌握，关腹快，并发症少，切口愈合时间短，术后疼痛明显减轻。

Objective To explore the application feasibility of MPS suture in abdominal incision closure. Methods Total 443 patients undergoing abdominal surgery were subjected to incision closure via differential suture methods and the length of incision in them was all more than 20 crn. The pa- tients were divided into two parts for study. For the part one study, total 360 patients underwent clo- sure procedure, in which 191 cases were given MPS suture and 169 cases given conventional layer-by- layer closure in abdominal wall. For the part two study, 83 patients underwent relaxation closure pro- cedure, in which 51 cases were given MPS suture and 32 cases were given conventional relaxation clo- sure. The follow-up period ranged from 1 month to 1 year. The incision complications and wound healing were targeted to comparison. Results For the part one study, in general group, no peritoneal broken and cut split, as well as adhesive intestinal obstruction and incisional hernia were seen in MPS group, but fat liquefy and infection were found in 3 cases. Regarding to the complications including cut split, adhesive intestinal obstruction and incisional hernia, the MPS group presented better efficacy （P〈0. 05）. For the part two study, there were 18 cases of peritoneal broken and 2 cases of cut split in conventional relaxation closure group, but there were no adhesive intestinal obstruction and incisional hernia, as well as fat liquefy and infection in wound. In this regards, no complications were seen in MPS group. Conclusion The continuous mass closure to abdominal incision using MPS suture is easy to be performed with fast closure and healing, as well as less pain in wound. [Key words] Abdominal wound closure techniques;Suture techniques