全层切口缝合在上腹部手术中应用.doc

全层切口缝合在上腹部手术中应用【摘要】 目的 观察上腹部手术切口全层丝线间断缝合关腹方法在临床中应用的效果。方法 2004年4月起至2009年1月对386例(新法组)贲门癌、胃癌等手术采用丝线间断全层关腹技术,并与2004年前的病例进行对照(对照组)分析。结果 两组患者年龄、性别、并发症比较差异无统计学意义。新法组I期愈合率98.8%,对照组I期愈合率为96.2%,差异有统计学意义。主要并发症切口裂开和感染的发生率,新法组为0.8%、1.6%,旧法组为2.5%、4.3%,差异有统计学意义。结论 全层丝线缝合切口愈合良好,便于操作,经济实用,适用于各种上腹部手术。 【关键词】 剖腹术;缝合技术;伤口愈合 【Abstract】 Objective To investigate application of abdominal closure technique by all layer in epigastric abdominal operation and evaluate the significance.Methods 386 cases with carcinoma of gastric cardia or stomach operation between Apr 2002 and Jan 2009 were subjected to single layer closure with non absorbable chorda serica chirurgicalis.The clinic data and some results of fouowup were contrasted to the cases with carcinoma of gastric cardia or stomach before Apr 2004.Results There were no statistical difference in general status between two groups.However,in new method group,rate of primary healing,dehiscence of wound,infection of infection was 98.8%,0.8%,1.6%respectively.In old group,rate of primary healing,dehiscence of wound,infection of infection was 96.2%,2.5%,4.3%respectively.There were statistical difference between them.Meanwhile,There were statistical difference in closure time between the new method group(14±4 min)and the old method group(16±5 min).Conclusion All layer closure of an abdominal incision could be effective,safe,economic and fast. 【Key words】 Laparotomy;Suture techniques;Wound healing DOI:10.3760/cma.j.issn2010.01.60 作者单位:454450河南省焦作煤业集团中央医院 腹部切口裂开、感染是腹部手术严重并发症。其原因不外乎局部因素和全身因素两大类。因此,探索简便实用的缝合技术势在必行。本院自04年起采用丝线全层间断缝合关腹,与旧法比较效果良好,现总结分析如下。 1 资料与方法 1.1 一般资料 新法组共386例,其中男271例、女115例;年龄48~72岁,合并高血压12例,合并糖尿病9例,同时合并高血压、糖尿病的6例。旧法组398例,其中男263例,女135例,年龄45~73岁,合并高血压18例,合并糖尿病11例,同时合并糖尿病高血压的8例。两组均采用腹正中或旁正中切口,切口长度18~30 cm。排除标准:已有全身转移,合并有冠心病以及有冠心病手术史,有放疗、化疗病史、血液病、结缔组织疾病的患者排除在研究范围外。 1.2 缝合方法 新法组采用10号丝线(中外合资杭州华威医疗用品有限公司)间断缝合腹白线或腹直肌后鞘、腹肌和前鞘,进针点距切口边缘810 mm,针距为9~12 mm,第一结为外科结,皮下脂肪较厚者放置硅胶引流管,4号丝线缝合皮肤。旧法组采用10号丝线逐层缝合关腹,余法