分层可拆线式缝合技术在腹壁切口缝合中的应用  

The Value of the Layered Suture Technique with Removal of Stitches in Abdominal Incision Closure

作　　者：陈钢[1] 庄哲宏[1] 刘业星[1] 张剑宝[1] 梁智浩 

机构地区：[1]深圳市第四人民医院广东医学院附属深圳福田医院胃肠外科,深圳518033

出　　处：《中国现代手术学杂志》2015年第6期414-417,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨深层可拆线式腹壁切口缝合技术的临床效果。方法 2008年9月~2014年8月间我科急诊及择期入组开腹手术患者365例,随机分成三组：研究组（n=167）、对照1组（n=109）及对照2组（n=89）,分别采用分层可拆线式缝合方法、深层非拆线式丝线分层缝合方法以及深层可吸收缝线＋浅层丝线分层缝合方法缝合腹壁手术切口。比较不同方法缝合腹壁切口的愈合情况。结果三组的拆线时间平均为8（7~21）d。三组患者随访时间为6个月~2.5年。研究组、对照1组、对照2组获随访率分别为91.6%（153/167）、90.8%（99/109）、92.1%（82/89）。三组术后需药物止痛、切口裂开及切口疝发生率比较差异无统计学意义（P〉0.05）,而皮肤线结反应、住院期切口感染、随访切口窦道形成及切口甲级愈合率比较差异有统计学意义（P〈0.05）。结论分层可拆线式缝合方法简单,能根据病情变化对切口愈合的影响个体化适时拆线,及时消除切口愈合后组织内残留缝线造成的不良影响,切口愈合可靠,并发症发生率低,有一定的临床实用价值,适合于不同部位和类型的腹壁切口缝合的需要。Objective To explore the clinical value of layered suture technique with removal of stitches in abdominal incision closure. Methods A total of 365 cases performed emergency or selective operation admitted from September 2008 to August 2014 in our department were randomized into three groups. During the closure of abdominal incision, the layered suture technique with removal stitches, traditional suture technique with silk line in all layers and the suture technique with absorbable line in deep layers and silk line in shallow layers were car- ried out in study group （ n = 167 ） , controlled group Ⅰ（ n = 109 ） and controlled group Ⅱ（ n = 89 ） respectively. The healing effect of abdominal incision were compared among three groups. Results The removal stitches time was 7 to 21 days with an average of 8 days in three groups. The follow-up duration was 6 months to 2.5 years. The follow-up rate was 91.6% （153/167）, 90.8% （99/109） and 92. 1% （82/89） in the study group, controlled group I and controlled group 11 respectively. There was statistic difference in suture reaction, postoperative infec- tion, incisional sinus rate and healing rate of grade A （ P 〈 0.05 ）, and no statistic difference in analgesics usage, incision dehiscence and ineisional hernia rate among three groups（P 〉 0.05）. Conclusions The technique of layered suture with removal stitches can remove the stitches individually and timely according to changes with dis- ease and wound healing, and relieve the adverse effect of residual suture line in healing wound. It is a simple and effective suture method in incision closure with reliable healing and lower complication rate.

关 键 词：腹壁切口 缝合技术 伤口愈合 拆线 

分 类 号：R656.3[医药卫生—外科学]