急诊手术腹部正中切口二种减张缝合方式的临床随机对照研究  

Simple interrupted retention suture versus interrupted mattress retention suture in emergency midline laparotomy: a randomized controlled trial

作　　者：孟繁杰[1] 李燕书[1] 马顺茂[1] 王海刚[1] 黎辉[1] 付泽娴[2] 曹斌[1] 

机构地区：[1]河北医科大学附属华北石油管理局总医院普外科,任丘062552 [2]河北医科大学

出　　处：《中华疝和腹壁外科杂志（电子版）》2014年第6期8-11,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：中国石油华北油田科技信息处基金资助项目(No.2013-HB-G19-2)

摘　　要：目的探讨急诊手术腹部正中切口二种减张缝合方式的区别。方法采用随机对照试验方法,将2007年1月至2009年2月河北医科大学附属华北石油管理局总医院收治的符合纳入标准的164例患者随机分为二组,试验组80例,采用单纯间断对合减张缝合法;对照组84例,采用间断外翻减张缝合法。比较二组患者术前基本情况、手术切口相关指标及术后全身切口恢复指标的差异。结果术前二组患者基线情况一致。术后二组患者在下床活动时间、术后经肛门排气时间、切口愈合级别、切口并发症发生率上,其差异均无统计学意义(t=1.239 5、0.251 5,χ2=0.030、4.721,P=0.217、0.802、0.985、0.193);在术后患者疼痛分值(NRS)上,试验组明显低于对照组,其差异有统计学意义(t=47.133 8,P=0.000)。试验组有3例切口完全哆开,给予再次全层缝合后,随访期间2例出现切口疝。结论就急诊手术腹部正中切口而言,单纯间断对合减张缝合法与间断外翻减张缝合法均是安全的关腹方法,但术后前者疼痛分值较高,还可能增加切口再次缝合机会和切口疝发生率。Objective To investigate the effect of two different suture techniques for abdominal median incision in emergency operation. Methods A randomized controlled trial was conducted in patients admitted from January 2007 to February 2009. A total of 164 eligible patients were divided into 2 groups. 80 patients in the trial group received simple interrupted retention suture, while 84 in the control group were performed with interrupted mattress retention suture. The preoperative baseline conditions, incision parameters, and the recovery of the body and incision after the operation were compared between the 2 groups. Results The baseline characteristics of the groups were similar. No significant differences were observed in terms of time to ground activity, and time to first passage of gas by anus, healing level of the incisions and complications of wound （t = 1. 239 5,0. 251 5 ,x^2 = 0. 030,4. 721, P = 0. 217,0. 802,0. 985, 0. 193）. However, the pain scores （NRS） after the operation was significantly lower in the trial group compared with the control group （t =47. 133 8,P =0.000）. In the trial group, 3 cases were received the secondary suture due to dehiscence of wound, and incisional hernia occurred in 2 cases in the follow-up period. Conclusions For emergency midline laparotomy, both simple interrupted retention suture and interrupted mattress retention suture are safe, but the former has lower pain scores in NRS and may also increase the incidence of wound dehiscence and henia.

关 键 词：急诊处理 随机对照试验 缝合技术 

分 类 号：R656[医药卫生—外科学]