横切口腹膜外单层缝合法用于阑尾脓肿切除的临床研究

Clinical study of transverse abdominal incision sutured by single layer extraperitoneal closure in treatment of appendiceal abscess

目的评价横切口腹膜外单层缝合法应用于阑尾脓肿切除的临床效果。方法纳入研究的阑尾脓肿需行手术治疗的患者197例,随机分成单层缝合组91例和分层缝合组106例,分别采用横切口腹膜外单层缝合法及常规经腹直肌切口分层缝合法进行阑尾脓肿切除术,对比2种手术方式的临床指标、医疗费用以及术后半年的并发症发生率。结果与分层缝合组比较,单层缝合组的手术时间短、术中出血量少、术后24 h内下床活动者多、肛门排气时间早、切口感染率低、7 d内切口Ⅰ期愈合并拆线率高、医疗费用低(P均<0.05)。2组患者在术后48 h内应用镇痛药者比例及并发症发生率比较差异均无统计学意义(P均>0.05)。结论应用横切口腹膜外单层缝合术行阑尾脓肿切除术具有操作简单、安全有效、经济实用等优点。

Objective To assess the clinical efficacy of transverse abdominal incision sutured by single layer extraperitoneal closure in the treatment of appendiceal abscess.Methods A total of 197 patients with appendiceal abscess scheduled to undergo surgery were enrolled and randomly divided into the single layer（n=91） and multi-layer suture groups（n=106）.In the single layer suture group,patients underwent transverse abdominal incision sutured by single layer extraperitoneal closure and those in the other group received transrectus incision sutured by multi-layer closure technique.Clinical parameters,medical expanse and the postoperative 6-month incidence of surgical complications were statistically compared between two groups.Results Compared with their counterparts in the multi-layer suture group,patients in the single layer suture group had significantly shorter operative time,less intraoperative blood loss,higher proportion of off-bed activity within postoperative 24 h and earlier anal exhaust time,lower incidence of incisional infection,higher rate of wound healing and suture removal within postoperative 7 d and lower medical cost（all P〈0.05）.There was no statistical significance in the percentage of analgesics users within postoperative 48 h and the incidence of postoperative complications between two groups（both P〉0.05）.Conclusion Transverse abdominal incision sutured by single layer extraperitoneal closure is a simple,efficacious,safe and low-cost technique to treat appendiceal abscess.