腹腔镜下≥10mm trocar切口缝合术改进的比较研究

Comparative Study on the Improvement of Suture for Laparoscopic Trocar Incision With a Length≥10 mm

目的比较腹腔镜下≥10 mm trocar切口腹腔内和腹腔外2种缝合术的临床效果。方法选取2017年3月~2023年3月我院妇科腹腔镜手术138例,按入院时间顺序分为2组:2017年3月~2020年3月传统组(腹腔镜手术腹腔外缝合皮肤及皮下组织,进行10~12 mm切口关闭)53例,2020年4月~2023年3月改良组(腹腔镜下腹腔内缝合筋膜、腹膜,进行10~12 mm切口关闭)85例,比较2组术后切口并发症情况。结果改良组术后切口液化1例,无其他并发症;传统组术后切口出血1例、切口感染2例、切口液化1例、切口裂开1例、切口疝1例。改良组术后切口并发症发生率1.2%(1/85),显著低于传统组11.3%(6/53)(χ^(2)=5.029,P=0.025)。结论妇科腹腔镜手术在腹腔镜下腹腔内缝合≥10 mm切口,术后切口并发症发生率明显降低,但操作难度较大,缝合技术要求高。

Objective To compare the clinical efficacy between laparoscopic suture and extraperitoneal suture for laparoscopic trocar incision with a length≥10 mm.Methods A total of 138 patients with gynecological surgery under laparoscopy admitted to our hospital from March 2017 to March 2023 were divided into two groups according to their admission time:53 cases in the traditional group(after laparoscopic surgery,the skin and subcutaneous tissue were sutured outside the peritoneum to close the trocar incision 10-12 mm in length)from March 2017 to March 2020,and 85 cases in the improved group(the fascia and peritoneum were sutured intraperitoneally under laparoscopy to close the trocar incision 10-12 mm in length)from April 2020 to March 2023.The postoperative incision complications were compared between the two groups.Results There was 1 case of postoperative incision liquefaction in the improved group,without other complications.There were 1 case of postoperative incision bleeding,2 cases of incision infection,1 case of incision liquefaction,1 case of incision dehiscence,and 1 case of incision hernia in the traditional group.The incidence of postoperative incision complications in the improved group was 1.2%(1/85),significantly lower than that in the traditional group[11.3%(6/53);χ^(2)=5.029,P=0.025].Conclusion After gynecological laparoscopic surgery,intra-abdominal suture of incision≥10 mm in length significantly reduces the incidence of postoperative incision complications,but the operation is difficult to perform and requires high suturing techniques.