创面封闭医用胶与结扎缝合法在肝胆手术创面封闭的临床疗效对比

Medical adhesive wound closure versus ligation suture for closing hepatobiliary surgical

目的对比分析创面封闭医用胶与结扎缝合法在肝胆手术创面封闭中的临床疗效，探讨其临床适用性。方法选择从2009年5月至2012年5月于我院确诊需要进行肝胆手术的60例患者，简单随机分为试验组30例和对照组30例，试验组采用创面封闭医用胶进行创面封闭止血，对照组采用常规结扎缝合法进行封闭止血处理。观察两组患者的手术时间、术后首次排气时间、进食时间、拔管时间、胆漏发生率和住院时间等情况，并观察两组患者术后肝功能情况及肝功能恢复正常的时间。结果试验组患者手术时间、术后首次排气时间、进食时间、拔管时间及平均住院时间分别为（3．21±2．09）h、（2．47±1．98）d、（3．34±2．03）d、（5．13±2．67）d、（12．37±3．79）d，均明显低于对照组，差异均有统计学意义（P〈0．05），试验组患者术后AST、ALT及TBil的变化水平[（235．7±20．4）U／L，（276．4±21．8）U／L，（33．1±7．4）mmol／L]均低于对照组，差异均有统计学意义（P〈0．05），试验组患者肝功能恢复正常的时间也早于对照组，差异有统计学意义（P〈0．05）.结论在肝胆手术创面封闭中，选择创面封闭医用胶具有更好的创面封闭止血效果，可以促进伤口尽快愈合，对术后肝功能的影响较小，适合临床长期推广应用。

Objective To compare the clinical efficacy of medical adhesive wound closure and ligation suture for closing hepatobiliary surgical wound. Methods 60 patients undertaking hepatobiliary surgery at our hospital from May, 2009 to May, 2012 were selected and then were randomly divided into an experimental group and a control group. The experimental group were conducted medical adhesive wound closure, while the control group were treated with conventional hemostatic suture ligation. The general operative situation, the postoperative liver function, and the time for the liver function recover to normal were observed. Results The operation time, postoperative first exhaustion time, eating time, extubation time, wound stitch time, and average length of hospital stay were （3.21±2.09） h, （2.47±1.98） d, （3.34±2.03） d, （5.13±2.67） d, （12.37±3.79） d, in the experimental group, which were significantly lower than those in the control group, with statistical differences （P〈0.05）; after the operation, the serum levels of AST, ALT, and TBil were （235.7±20.4） U/L, （276.4±21.8） U/L, and （33.1±7.4）mmol/L in the experimental group, which were better than those in the control group, with statistical differences （P 〈0.05）; the time for the liver function recover to normal was shorter in the experimental group than in the control group, with a statistical difference （P〈0.05）. Conclusions Medical adhesive wound closure for closing hepatobiliary surgical wound has better hemostatic effect, can promote wound healing as soon as possible, has little influence on postoperative liver function, and is worth being clinically generalized.