改良式缝合在妇科恶性肿瘤肥胖患者开腹手术中的应用

Application of modified suture in laparotomy of obese patients with gynecologic malignancies

目的探讨改良式缝合在妇科恶性肿瘤肥胖患者开腹手术中的应用效果。方法回顾性选取2021年1月至2022年11月江西省妇幼保健院肿瘤科就诊的90例妇科恶性肿瘤肥胖患者作为研究对象,按照手术缝合方法不同分为对照组1(30例)、对照组2(30例)、观察组(30例),对照组1采用分层间断缝合,对照组2采用分层连续缝合+腹壁全层减张缝合,观察组则采用改良式缝合法。比较三组患者的临床指标(关腹缝合时间、腹部切口渗液量、住院时间)、视觉模拟评分法(VAS)评分和切口瘢痕状态(POSAS)评分。比较各组患者手术后切口愈合率和感染率。结果观察组关腹缝合时间、手术切口瘢痕宽度、住院时间短于对照组1、对照组2,差异有统计学意义(P<0.05);对照组1与对照组2关腹缝合时间、手术切口瘢痕宽度、住院时间比较,差异无统计学意义(P>0.05);观察组VAS评分和POSAS评分低于对照组1、对照组2,差异有统计学意义(P<0.05);对照组1与对照组2VAS评分和POSAS评分比较,差异无统计学意义(P>0.05);三组患者切口愈合情况、感染率比较,差异无统计学意义(P>0.05);各组间切口愈合情况、感染率两两比较,差异无统计学意义(P>0.05)。结论改良式缝合在妇科恶性肿瘤肥胖患者开腹手术中的应用效果较好,能够缩短缝合时间以及住院时间,降低术后感染率和疼痛程度。

Objective To explore the application effect of modified suture in the laparotomy of obese patients with gynecologic malignancies.Methods A total of 90 obese patients with gynecologic malignancies treated in the Department of Oncology of Jiangxi Maternal and Child Health Hospital from January 2021 to November 2022 were retrospectively selected as the research objects,and they were divided into control group 1(30 cases),control group 2(30 cases)and observation group(30 cases)according to different surgical suture methods.The control group 1 was treated with stratified intermittent suture,the control group 2 was treated with layered continuous suture+full-layer abdominal wall relaxation suture,and the observation group was treated with modified suture.The clinical indexes(laparotomy suture time,abdominal incision fluid volume,hospital stay),visual analogue scale(VAS)score and patient and observer scar assessment scale(POSAS)score were compared among the three groups.The wound healing rate and infection rate were compared among all groups.Results The time of abdominal closure suture,scar width of surgical incision and hospital stay in observation group were shorter than those in control group 1 and control group 2,the differences were statistically significant(P<0.05).There were no significant differences between control group 1 and control group 2 in abdominal closure suture time,surgical incision scar width and hospital stay(P>0.05).VAS score and POSAS score in observation group were lower than those in control group 1 and control group 2,and the differences were statistically significant(P<0.05).There were no significant differences in VAS score and POSAS score between control group 1 and control group 2(P>0.05).There were no significant differences in wound healing and infection rate among the three groups(P>0.05).There were no significant differences in incision healing and infection rate among all groups(P>0.05).Conclusion The application of modified suture in in the laparotomy of obese patients with gynecologic malignancies is good,can shorten the suture time and hospital stay,reduce the postoperative infection rate and pain degree.