剖宫产术腹壁横切口4种不同缝合方法的效果比较

Comparison of different skin and subcutaneous tissue suturing methods for abdominal transverse incision in caesarean section

目的比较剖宫产术中腹壁横切口4种不同缝合法缝合皮下脂肪及皮肤层的愈合效果。方法 400例行剖宫产术产妇分为4组,每组100例。A组:3-0可吸收缝线皮下脂肪层间断缝合+5-0可吸收缝线皮内连续缝合;B组:皮下脂肪层不缝+5-0可吸收缝线皮内连续缝合;C组:3-0可吸收缝线皮下脂肪层间断缝合+皮肤缝合器缝合皮肤;D组:皮下脂肪层不缝+皮肤缝合器缝合皮肤。完成随访共393例。评价指标:(1)术后切口疼痛程度:术后3d、6周采用视觉模拟评分法(VAS)评估;(2)切口并发症:术后至6周切口感染、裂开、血肿、渗液、线结反应或硬结等情况;(3)切口缝合时间、医疗成本。(4)术后4个月产妇对手术瘢痕的舒适度和满意度的评估,美容科医生对手术瘢痕的满意度评估:最低0分,最高4分。结果(1)4组产妇术后第3天腹壁切口疼痛程度B组与D组更轻,B组明显轻于A组(P<0.05),其他各组两两比较均无统计学差异(均P>0.05)。(2)切口并发症,D组发生率明显低于A组(P<0.05),主要是线结反应或硬结,其他各组两两比较无统计学差异。(3)缝合时间:各组间两两比较均有统计学差异(均P<0.01),其中D组时间最短,B组次之,A组最长。缝合成本B组最低,C组最高。(4)4组产妇对腹部瘢痕舒适度比较,D、B两组舒适度明显高于A、C两组,均有统计学差异(均P<0.05);产妇对瘢痕的满意度评分B组最高,C组最低,但各组间均无统计学差异(均P>0.05);美容科医生对4组产妇腹部疤痕的满意度评分,D组最高,B、C、A组依次降低,而且D、B两组满意度明显高于A、C两组,均有统计学差异(均P<0.05)。结论不缝合皮下脂肪层,尤其用皮肤缝合器缝合组不管从缝合的时间、产妇对切口的舒适度、美容科医生对切口满意度评估更优于皮下脂肪缝合组。

Objective To compare different suturing methods of skin and subcutaneous tissue for abdominal transverse incision in caesarean section. Methods Four hundred women undergoing caesarean section were randomly assigned to four groups with 100 cases in each group. Group A：closure of the skin by continuous intracutaneous suturing with 3- 0 absorbable sutures and closure of the subcutaneous tissue by interrupted suturing with 5- 0 absorbable sutures;Group B：closure of the skin by continuous intracutaneous suturing and non- closure of the subcutaneous space;Group C：closure of the skin with staples and closure of the subcutaneous tissue by interrupted suturing with 3- 0 absorbable sutures;Group D：closure of the skin with staples and non- closure of the subcutaneous space. The pain of incision was evaluated by using visual analogue scale （VAS） at 3d, 6w after operation. The incision complications within 6 weeks after operation were documented, including incision infection, dehis-cence, hematoma, drainage, knotting reaction and induration. Cut- suture time and medical costs were also recorded. Patients were asked to complete a survey regarding her comfort level;the satisfaction with the scar were evaluated by both patients and cosmetic surgeons 4 weeks after operation, which was rated as 0~4. Results The degree of pain in group B was significantly lower than that in group A （P〈0.05）. The incidence of incision complications in Group D was significantly lower than that in group A （P=0.34）. There were significant differences in suture time among groups （P〈0.01）：that in group D was the shortest and in group A was the longest. The medical coat in group B was the lowest and that in group C was the highest. The comfort level with the scar by patients in groups D and B was significant higher than that in groups A and C. The satisfaction with the scar by cos-metic surgeons in group D and B was significant higher than that in group A and C, and group D was the highest. Conclusion Non- closure of the subcutaneous space, particularly closure of the skin with staples have better cosmetic effect and shorter su-ture time, should be be a reasonable choice for abdominal transverse incision in caesarean section.