全层缝合法关闭腹部Ⅲ类切口的应用探讨

Application of Single-layer Suture in Closure of Abdominal Incision with Type Ⅲ

目的比较腹部Ⅲ类切口采用全层缝合法与传统分层缝合法关腹的效果,以指导其临床应用。方法 2004年4月～2011年3月行急诊开腹手术且符合Ⅲ类切口标准的患者298例,观察组162例采用全层缝合法关腹,对照组136例采用分层缝合法关腹。观察并比较两组患者术后切口并发症的发生情况。结果观察组与对照组平均手术时间及平均出血量比较差异均无统计学意义(110.9 vs.129.7,90.8 vs.115.3,P>0.05)。观察组术后使用镇痛药物患者比例高于对照组(22.2%vs.11.0%,P<0.05),术后早期(48 h内)下床活动患者比例低于对照组(38.3%vs.72.1%,P<0.01),平均拆线时间延长(15.4 vs.8.4,P<0.01)。观察组术后发生并发症21例(13.0%),对照组50例(36.8%),组间比较差异有统计学意义(P<0.01)。观察组切口感染、全层裂开、窦道形成发生率均低于对照组,差异有统计学意义(P<0.05),而在切口脂肪液化、切口疝发生率较对照组差异无统计学意义(P>0.05)。对于不存在弥漫性腹膜炎、手术时间长,肥胖、糖尿病等危险因素的患者,两组术后各种切口并发症发生率比较差异无统计学意义(P>0.05)。结论全层缝合能降低腹部Ⅲ类切口感染、窦道形成、全层裂开的发生率,但拆线时间延长,术后疼痛感更明显,早期下床活动者减少,更适用于存在弥漫性腹膜炎、手术时间长,肥胖、糖尿病等危险因素的患者。

Objective To compare the effect of single-layer suture and traditional layered suture in the closure of abdominal incision with typeⅢ, and to guide the clinical application. Methods From April 2004 to March 2011, a total of 298 cases were performed emergency abdominal operations. Among them, 162 pa- tients regarded as observation group were carried out single-layer suture, while 136 patients regarded as control group were performed layered suture. All incisions met the standard of type Ⅲ. The postoperative wound com- plications were observed and compared. Results There was no statistic difference in average operative dura- tion and blood loss between observation group and control group（ 110.9 vs. 129.7, 90.8 vs. 115.3, P 〉0.05）. Compared with control group, the rate of patients using postoperative analgesic was higher （22.2% vs. 11.0%, P 〈 0. 05）, the rate of out-of-bed activity during 48 hours after operation was lower（38.3% vs. 72. 1%, P 〈 0. 01 ）, and the time of stitches remove was delayed（ 15.4 vs. 8.4, P 〈 0.01 ）. The postoperative incision complication was found in 21 cases （ 13.0% ） in the observation group and 50 cases in the control group, and there was obviously difference between two groups （P 〈 0.01 ）. The incidences of wound infection, w6und dehiscence and sinus formation in the observation group were significantly lower than those in the control group （ P 〈 0.05 ） ; but there were no significant differences in the incidences of incision liquefied and incisional hernia formation between two groups（P 〉0.05）. There were no statistic differences of the incision complication incidences for the patients with or without high risk factors as diffuse peritonitis, long operation time, obesity and diabetes（P 〉 0.05 ）. Conclusions Single-layer suture can reduce the incidences of wound infection, sinus formation and wound de- hiscence, but postpone the time for take out stitches, aggravate the postoperative pain and astrict the early mo- bihzation. The suture technique may be more suited to the patients with high risk factors as diffuse peritonitis, long operation time, obesity and diabetes.