ETHICON可吸收缝线用于腹膜与腹白线(腹直肌前后鞘)作单层缝合和分层缝合的对比观察

It is the review on using single-layer closure technique in stitching peritoneum and linea alba(or anterior/posterior rectus sheath)with absorbable sutures as compared with layered closure technique.

目的 应用新材料 ,探讨和改进新的腹部切口缝合技术。方法 对 135例正中切口、旁正中切口的腹部手术病人 ,应用 0号 ETHICON普迪思圈套可吸收缝线 ,将腹膜与腹白线或腹膜与腹直肌前后鞘作单层连续缝合 ,并与同期 78例分层缝合法的病例进行比较。对其临床资料进行回顾性分析。结果 单层缝合组 :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 6例 (4 .4% )。分层缝合组 :术中缝合腹膜撕裂 12例 (15 % ) ;切口裂开 2例 (2 .5 % ) ;粘连性肠梗阻 4例 (5 % ) ,其中 2例在围手术期内均因粘连性肠梗阻再次手术 ;伤口皮下脂肪液化、积液或感染 13例 (16 .6 % ) ;切口疝 1例 (1.3% )。结论 本方法简便 ,易掌握 ,并发症少 ,有助于解决术中缝合撕裂腹膜、关腹困难、手术时间拖延等手术者经常出现的难题 ,尤其适合于一些极度肥胖病人、急危重病人抢救、术中麻醉效果差和腹肌紧张病人的应用。

Objective To discuss the techniques used in closing abdomen with new material.Methods By comparing 135 cases using single-layer closure technique to stitch peritoneum and linea alba(or anterior/posterior rectus sheath)with #0 ETHICON springe absorbable sutures to 78 same-term cases using layered closure technique,collected and analyzed the clinical data,then made the review.Results The single-layer closure group:there were no patients suffered peritoneum dehiscence when closing the abdomen,there were no postoperative complications such as wound dehiscence,peritoneum dehiscence and bowel olstruction incisional hemia etc.There were 6 patients suffered subcutaneous fat liquefy,dropsy or wound infection.The layered closure group there were 12 patients suffered peritoneum dehiscence when closing the abdomen.Bowel olstruction in 4 cases(5%),2 of them had to experience another operation for adhesiveileus.dehiscence of abdomen wound in 2 cases(2.5%),13 patients suffered subcutaneous fat liquefy or dropsy.incisional hemia in 1 patients(1.3%).Conclusion This technique is an easy and rapid procedure with less complications,it can deal with some difficult cases in operating such as peritoneum dehiscence,difficult aodomen closure,prolonged operative time and etc.It was a favorable chose when performing surgery in the obese,seriouslyill or critical patient or the patient who has poor narcotic effect or abdominal muscular tension.