不缝合皮下脂肪层的切口缝合方式在腹部外科的应用

Application of Abdominal Wall Closure Measure Without Suturing Subcutaneous Fat Layer in Abdominal Surgery

目的比较不缝合皮下脂肪层的关腹方式与传统关腹方式的切口愈合效果。方法选取2010年9月至2012年9月期间笔者所在医院科室收治的患者400例,随机分为2组:观察组199例,采用不缝合皮下脂肪层的缝合方式;对照组201例,采用传统的分层缝合方式。比较2组患者的切口愈合效果。结果观察组发生脂肪液化1例(0.5%)、切口红肿3例(1.5%)、切口硬结1例(0.5%)、切口裂开0例及皮下血肿2例(1.0%),对照组上述并发症的发生数量分别为18例(9.0%)、16例(8.0%)、15例(7.5%)、9例(4.5%)及0例,除皮下血肿发生率的差异无统计学意义(P>0.05)外,观察组其余切口并发症的发生率均低于对照组(P<0.01)。观察组切口全部一期愈合(100%),对照组愈合186例(92.5%),观察组的一期愈合率较高(P<0.01)。观察组的关腹时间和术后住院时间分别为(13.0±1.6)min和(7.7±1.3)d,均短于对照组〔(18.0±2.2)min,(9.6±1.9)d,P<0.01〕。结论不缝合皮下脂肪层的切口缝合方式的切口愈合效果明显优于传统的分层缝合方式,值得推广。

Objective To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure. Methods Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer, and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed. Results The incidences of fat liquefication ~ 1 （0.5%） vs. 18 （9. 0%） 3, incision swelling I3 （1.5%） vs. 16 （8.0%） 3, incision induration ~ 1 （0.5%） vs. 15 （7. 5%） 3, and dehiscence of wound I0 （0） vs. 9 （4. 5%） 3 in observation group were significantly lower than those of control group （P〈0.01）, but there was no significant difference in incidence of subcutaneous hematoma [2 （1.0%） vs. 0 （0）, P〉0. 053. The rate of primary healing in obser- vation group was significantly higher than those of control group [ 199 （100%） vs. 186 （92.5%）, P〈0.01 ） Duration of abdominal closure （ （13.0±1.6） min vs. （18. 0±2. 2） rain3 and postoperative hospital stay[（7.7± 1.3） days vs. （9.6±1.9） days 3 were all shorter than those of control group （P〈0.01）. Conclusion The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique, which is a suture way worthy to spread.