CAJ | 학술논문

目的：探讨负压下脂肪层不缝合的腹部切口缝合法在结直肠肿瘤手术中的应用.方法选择2010年1月~2012年12月辽宁省肿瘤医院手术治疗的结直肠肿瘤患者540例,按单双号分为A、B两组,每组各270例.A组为对照组,常规缝合切口,B组为实验组,皮下脂肪层不缝合. B组根据是否采用负压分为B1组80例和B2组190例,B1组采用非负压下脂肪层不缝合,B2组采用负压下脂肪层不缝合.观察并比较各组切口愈合情况及术后住院时间等.结果 B1组和B2组患者切口感染率(2.50%、1.58%)、切口裂开率(2.50%、1.58%)及术后住院天数[(8.2±1.1)、(9.1±1.5)d]均明显低于A组[8.15%、6.67%、(12.0±3.8)d],差异均有统计学意义(P<0.05)；B1组和B2组比较差异无统计意义(P>0.05). B1组切口出血率(21.25%)及切口渗液率(16.25%)明显高于A组(4.44%、4.44%)和B2组(1.05%、1.05%),差异有统计学意义(P<0.05)；B2组切口出血率及切口渗液率(1.05%、1.05%)明显低于A组(4.44%、4.44%)和B1组(21.25%、16.25%),差异均有统计学意义(P<0.05).结论皮下脂肪层不缝合可以减少切口感染、切口裂开的风险,缩短术后住院时间,但增加切口积液和出血的风险,不过此问题在采取给脂肪层造成负压状态缝合皮肤后就大大降低。
목적：탐토부압하지방층불봉합적복부절구봉합법재결직장종류수술중적응용.방법선택2010년1월~2012년12월요녕성종류의원수술치료적결직장종류환자540례,안단쌍호분위A、B량조,매조각270례.A조위대조조,상규봉합절구,B조위실험조,피하지방층불봉합. B조근거시부채용부압분위B1조80례화B2조190례,B1조채용비부압하지방층불봉합,B2조채용부압하지방층불봉합.관찰병비교각조절구유합정황급술후주원시간등.결과 B1조화B2조환자절구감염솔(2.50%、1.58%)、절구렬개솔(2.50%、1.58%)급술후주원천수[(8.2±1.1)、(9.1±1.5)d]균명현저우A조[8.15%、6.67%、(12.0±3.8)d],차이균유통계학의의(P<0.05)；B1조화B2조비교차이무통계의의(P>0.05). B1조절구출혈솔(21.25%)급절구삼액솔(16.25%)명현고우A조(4.44%、4.44%)화B2조(1.05%、1.05%),차이유통계학의의(P<0.05)；B2조절구출혈솔급절구삼액솔(1.05%、1.05%)명현저우A조(4.44%、4.44%)화B1조(21.25%、16.25%),차이균유통계학의의(P<0.05).결론피하지방층불봉합가이감소절구감염、절구렬개적풍험,축단술후주원시간,단증가절구적액화출혈적풍험,불과차문제재채취급지방층조성부압상태봉합피부후취대대강저。
Objective To investigate the application of suture of method of incision without suturing fat layer under negative pressure in colorectal cancer surgery. Methods A total of 540 patients of colorectal carcinoma from January 2010 to December 2012 in Liaoning Cancer Hospital & Institute were selected divided into two groups according to treatment order with 270 cases in each group. Group A was the control group, and the patients in the control group were treated with conventional suture incision, group B was the experiment group, and the patients in the experiment group were performed with subcutaneous fat layer suture. The group B was divided into group B1 with 80 cases and group B2 with 190 cases. Group B1 was sewed up the incision without negative pressure and fat layer suture; group B2 was sewed up the incision with suturing fat layer under negative pressure. The incision healings and the hospitalization days were observed and compared between the 3 groups. Results The wound infection rates (2.50%, 1.58%), wound de-hiscence rates (2.50%, 1.58%) and hospitalization days [(8.2±1.1), (9.1±1.5) days] in group B1and group B2 were lower than those in group A [8.15%, 6.67%, (12.0±3.8) days], the differences were statistically significant (P<0.05); the dif-ferences between group B1 and group B2 was not statistically significant (P>0.05). The incidence of incision bleeding and fat liquefaction in group B1 (21.25%, 16.25%) were higher than those in group A (4.44%, 4.44%) and group B2 (1.05%, 1.05%), the differences were statistically significant (P<0.05). The incision bleeding rate and the fat liquefaction rate of group B2 (1.05%, 1.05%) were lower than those of group A (4.44%, 4.44%) and group B1 (21.25%, 16.25%), the differences were statistically significant (P<0.05). Conclusion Application of non-suture of subcutaneous fat layer can reduce the risk of wound infections and fat liquefac-tion and shorten hospitalization days, but can increase the risk of bleeding and wound fluid. The suture with-out suturing subcutaneous fat layer under the negative pressure can well solve this problem.