目的 比較不縫合皮下脂肪層的關(guān)腹方式與傳統(tǒng)關(guān)腹方式的切口愈合效果。
方法 選取2010年9月至2012年9月期間筆者所在醫(yī)院科室收治的患者400例,隨機分為2組:觀察組199例,采用不縫合皮下脂肪層的縫合方式;對照組201例,采用傳統(tǒng)的分層縫合方式。比較2組患者的切口愈合效果。
結(jié)果 觀察組發(fā)生脂肪液化1例(0.5%)、切口紅腫3例(1.5%)、切口硬結(jié)1例(0.5%)、切口裂開0例及皮下血腫2例(1.0%),對照組上述并發(fā)癥的發(fā)生數(shù)量分別為18例(9.0%)、16例(8.0%)、15例(7.5%)、9例(4.5%)及0例,除皮下血腫發(fā)生率的差異無統(tǒng)計學(xué)意義(P>0.05)外,觀察組其余切口并發(fā)癥的發(fā)生率均低于對照組(P<0.01)。觀察組切口全部一期愈合(100%),對照組愈合186例(92.5%),觀察組的一期愈合率較高(P<0.01)。觀察組的關(guān)腹時間和術(shù)后住院時間分別為(13.0±1.6) min和(7.7±1.3) d,均短于對照組〔(18.0±2.2) min,(9.6±1.9) d,P<0.01〕。
結(jié)論 不縫合皮下脂肪層的切口縫合方式的切口愈合效果明顯優(yōu)于傳統(tǒng)的分層縫合方式,值得推廣。
引用本文: 戈偉,陳剛,丁義濤. 不縫合皮下脂肪層的切口縫合方式在腹部外科的應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(12): 1396-1400. doi: 復(fù)制
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2. | Milewski PJ, Thomson H. Is a fat stitch necessary?[J]. Br J Surg, 1980, 67(6):393-394. |
3. | Ferris BD, Wickens D, Bhamra M, et al. To stitch or not to stitchthe fat?[J]. Ann R Coll Surg Engl, 1989, 71(2):115-116. |
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6. | Thomay AA, Daley JM, Sabo E, et al. Disruption of interleukin-1 signaling improves the quality of wound healing[J]. Am J Pathol, 2009, 174(6):2129-2136. |
7. | 陳孝平. 外科學(xué)[M]. 北京:人民衛(wèi)生出版社, 2005:236-239. |
8. | Hunt TK, Hopf HW. Wound healing and wound infection. What surgeons and anesthesiologists can do[J]. Surg Clin North Am, 1997, 77(3):587-606. |
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10. | Larsson A, Engström M, Uusijärvi J, et al. Hyperbaric oxygen treatment of postoperative neurosurgical infections[J]. Neurosurgery, 2008, 62 Suppl 2:652-671. |
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15. | 朱笑寒, 桂世濤, 王亮. 全層連續(xù)加減張縫合預(yù)防高齡患者腹部切口裂開[J]. 中國醫(yī)學(xué)創(chuàng)新, 2009, 6(32):35-37. |
16. | 徐世平, 張馳. 全層連續(xù)加內(nèi)減張縫合在預(yù)防腹壁切口裂開的應(yīng)用[J]. 河南外科學(xué)雜志, 2009, 15(3):18-19. |
17. | Baracs J, Huszár O, Sajjadi SG, et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ):a randomized multicenter study[J]. Surg Infect (Larchmt), 2011, 12(6):483-489. |
18. | Huszár O, Baracs J, Tóth M, et al. Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures—a multi-center, randomized clinical study[J]. Magy Seb, 2012, 65(3):83-91. |
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22. | Berretta R, Rolla M, Patrelli TS, et al. Randomised prospective study of abdominal wall closure in patients with gynaecological cancer[J]. Aust N Z J Obstet Gynaecol, 2010, 50(4):391-396. |
23. | Justinger C, Slotta JE, Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures[J]. Surgery, 2012, 151(3):398-403. |
24. | van’t Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysisof techniques for closure of midline abdominal incisions[J]. Br J Surg, 2002, 89(11):1350-1356. |
- 1. Ferguson DJ. Clinical application of experimental relations between technique and wound infection[J]. Surgery, 1968, 63:377-381.
- 2. Milewski PJ, Thomson H. Is a fat stitch necessary?[J]. Br J Surg, 1980, 67(6):393-394.
- 3. Ferris BD, Wickens D, Bhamra M, et al. To stitch or not to stitchthe fat?[J]. Ann R Coll Surg Engl, 1989, 71(2):115-116.
- 4. Elson RA. Complications of the wound//Ling RSM. Complica-tions of total hip replacements[M]. Edinburgh:Churchill Livin-gstone, 1984:41-57.
- 5. Kong K, Jeyagopal N, Davies SJ. Should we still stitch the subcu-taneous fat layer? A clinical and ultrasound assessment in 50 hip operations[J]. Ann R Coll Surg Engl, 1993, 75(1):23-25.
- 6. Thomay AA, Daley JM, Sabo E, et al. Disruption of interleukin-1 signaling improves the quality of wound healing[J]. Am J Pathol, 2009, 174(6):2129-2136.
- 7. 陳孝平. 外科學(xué)[M]. 北京:人民衛(wèi)生出版社, 2005:236-239.
- 8. Hunt TK, Hopf HW. Wound healing and wound infection. What surgeons and anesthesiologists can do[J]. Surg Clin North Am, 1997, 77(3):587-606.
- 9. Larsson A, Uusijärvi J, Lind F, et al. Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity[J]. Eur Spine J, 2011, 20(12):2217-2222.
- 10. Larsson A, Engström M, Uusijärvi J, et al. Hyperbaric oxygen treatment of postoperative neurosurgical infections[J]. Neurosurgery, 2008, 62 Suppl 2:652-671.
- 11. Korhonen K. Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions[J]. Ann Chir Gynaecol, 2000, 89 Suppl 214:7-36.
- 12. Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients[J]. Arch Surg, 1997, 132(9):997-1004.
- 13. Kabon B, Rozum R, Marschalek C, et al. Supplemental posto-perative oxygen and tissue oxygen tension in morbidly obesepatients[J]. Obes Surg, 2010, 20(7):885-894.
- 14. Bakri MH, Nagem H, Sessler DI, et al. Transdermal oxygen does not improve sternal wound oxygenation in patients recoveringfrom cardiac surgery[J]. Anesth Analg, 2008, 106(6):1619-1626.
- 15. 朱笑寒, 桂世濤, 王亮. 全層連續(xù)加減張縫合預(yù)防高齡患者腹部切口裂開[J]. 中國醫(yī)學(xué)創(chuàng)新, 2009, 6(32):35-37.
- 16. 徐世平, 張馳. 全層連續(xù)加內(nèi)減張縫合在預(yù)防腹壁切口裂開的應(yīng)用[J]. 河南外科學(xué)雜志, 2009, 15(3):18-19.
- 17. Baracs J, Huszár O, Sajjadi SG, et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ):a randomized multicenter study[J]. Surg Infect (Larchmt), 2011, 12(6):483-489.
- 18. Huszár O, Baracs J, Tóth M, et al. Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures—a multi-center, randomized clinical study[J]. Magy Seb, 2012, 65(3):83-91.
- 19. Gupta H, Srivastava A, Menon GR, et al. Comparison of interrupted versus continuous closure in abdominal wound repair:a meta-analysis of 23 trials[J]. Asian J Surg, 2008, 31(3):104-114.
- 20. Chelmow D, Rodriguez EJ, Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery:a meta-analysis[J]. Obstet Gynecol, 2004, 103(5 Pt 1):974-980.
- 21. Fischer JE. The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure[J]. Am J Surg, 2009, 197(1):131-132.
- 22. Berretta R, Rolla M, Patrelli TS, et al. Randomised prospective study of abdominal wall closure in patients with gynaecological cancer[J]. Aust N Z J Obstet Gynaecol, 2010, 50(4):391-396.
- 23. Justinger C, Slotta JE, Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures[J]. Surgery, 2012, 151(3):398-403.
- 24. van’t Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysisof techniques for closure of midline abdominal incisions[J]. Br J Surg, 2002, 89(11):1350-1356.