CAJ | 학술논문

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＝1．2395、0．2515，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＝47．1338，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。
목적：탐토급진수술복부정중절구이충감장봉합방식적구별。방법채용수궤대조시험방법，장2007년1월지2009년2월하북의과대학부속화북석유관리국총의원수치적부합납입표준적164례환자수궤분위이조，시험조80례，채용단순간단대합감장봉합법；대조조84례，채용간단외번감장봉합법。비교이조환자술전기본정황、수술절구상관지표급술후전신절구회복지표적차이。결과술전이조환자기선정황일치。술후이조환자재하상활동시간、술후경항문배기시간、절구유합급별、절구병발증발생솔상，기차이균무통계학의의（t＝1．2395、0．2515，χ2＝0．030、4．721，P＝0．217、0．802、0．985、0．193）；재술후환자동통분치（NRS）상，시험조명현저우대조조，기차이유통계학의의（t＝47．1338，P＝0．000）。시험조유3례절구완전치개，급여재차전층봉합후，수방기간2례출현절구산。결론취급진수술복부정중절구이언，단순간단대합감장봉합법여간단외번감장봉합법균시안전적관복방법，단술후전자동통분치교고，환가능증가절구재차봉합궤회화절구산발생솔。
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 1 64 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,χ2 =0.030,4.721 ,P=0.21 7,0.802,0.985, 0.193).However,the pain scores (NRS)after the operation was significantly lower in the trial group compared with the control group (t=47.1 33 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.