单向倒刺线在腹腔镜子宫切除术后阴道残端缝合中的应用特点

Application characteristics of unidirectional barbed wire in suture of vaginal stump after laparoscopic hysterectomy

背景:腹腔镜下子宫切除后需要缝合阴道残端,而阴道残端伤口的愈合对患者术后恢复具有重要意义,不同材质缝线可能影响阴道残端的愈合,影响患者术后康复。目的:简要回顾腹腔镜子宫切除术后阴道残端缝合中使用单向倒刺线和普通可吸收缝线缝合效果的相关研究,阐述单向倒刺线在该术式中的应用及研究进展。方法:在PubMed、Web of Science、万方、CKNI数据库检索2013至2019年发表的相关文献,中文关键词为“倒刺线;全子宫切除术;腹腔镜手术;可吸收缝线;阴道残端;干细胞”,英文关键词为“Unidirectional Barbed Wire;hysterectomy;Laparoscopic;Available Absorbable Suture;Vaginal Stump;Stem Cell”。结果与结论:腹腔镜子宫切除术后使用单向倒刺线缝合阴道残端,具有缝合时间短、缝合难度低、术中出血少等优势。关研究表明单向倒刺线缝合未增加阴道残端相关并发症,在一定程度上由于无线结使缝线更易被吸收,利于残端愈合。但上述研究是基于腹腔镜下连续缝合的比较,对于使用单向倒刺线和普通可吸收缝线经阴道连续缝合效果的比较尚缺乏相关研究。而对于单向倒刺线是否可减少阴道残端的缝合时间,仍需要大样本随机对照试验进一步研究。另外,单向倒刺线用于腹腔镜下子宫切除术后缝合阴道残端,对远期盆腔脏器脱垂的预防效果仍需进一步研究。

BACKGROUND:Laparoscopic hysterectomy requires vaginal stump suture,and the healing of the vaginal stump wound is of great significance for postoperative recovery.Different material sutures may affect the healing of the vaginal stump and affect the postoperative recovery.OBJECTIVE:To briefly review the studies regarding the efficacy of unidirectional barbed wire and common absorbable wire in the suture of vaginal stump after laparoscopic hysterectomy,and clarify the application and advance progress of unidirectional barbed suture.METHODS:A computer-based online search of PubMed,Web of Science,Wanfang and CNKI databases was performed for papers published during 2013-2019 with the search terms“unidirectional barbed wire;hysterectomy;laparoscopic available absorbable suture;vaginal stump;stem cell”in Chinese and English,respectively.RESULTS AND CONCLUSION:After laparoscopic hysterectomy,vaginal stump was sutured by a unidirectional barbed wire,which had the advantages of short suture time,low suturing difficulty,and less intraoperative bleeding.Relevant study showed that the unilateral barbed wire did not increase the complications associated with the vaginal stump,and to some extent,the suture was more easily absorbed because of knots,which facilitated the healing of the stump.However,the above studies are based on the comparison of continuous sutures under laparoscopy,and little is reported on the efficacy of continuous vaginal suture using a unilateral barbed wire versus absorbable wire.Whether the unilateral barbed wire can shorten the time taken for vaginal stump should be further investigated by randomized controlled trials involving larger sample sizes.In addition,the preventive effects of unilateral barbed wire used for suture of vaginal stump after laparoscopic hysterectomy on long-term pelvic organ prolapse are still to be further studied.