肝脏手术切口一次性皮肤缝合器与普通丝线缝合的临床对照观察

发布时间：2018-03-15 06:28

本文选题：肝脏手术　切入点：肝癌　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨一次皮肤缝合器与普通丝线两种缝合材料于肝脏手术皮肤缝合中的优劣,为术中选择合适的缝合方法提供指导。方法我们选取了2016年1月至2017年1月在广西医科大学附属肿瘤医院的肝脏手术患者106例,随机分为普通丝线缝合组(n=51)或一次性皮肤缝合器组(n=55)。比较术后切口并发症的发生率、术后疼痛程度、术后住院时间以及1个月后瘢痕增生等情况。结果在肝脏手术中,一次性皮肤缝合器组出现切口并发症9例,约占16.4%,其中切口脂肪液化8例,约占14.6%,切口裂开1例,约占1.8%,切口感染0例,假性愈合0例。传统普通丝线缝合组出现切口并发症14例,约占27.5%,其中切口脂肪液化8例,约占15.7%,切口感染2例,约占3.9%;切口裂开2例,约占3.9%;假性愈合2例,约占3.9%。两组患者切口并发症率差异无统计学意义(p=0.285)。一次性皮肤缝合器组术后平均住院时间为14.1天,普通丝线缝合组术后平均住院时间为14.3天,差异无统计学意义(p=0.849);一次性皮肤缝合器组术后使用镇痛药平均3.2次,普通丝线缝合组术后使用镇痛药平均2.1次,差异无统计学意义(p=0.241);一次性皮肤缝合器组术后1个月切口瘢痕增生有13例,约占23.6%,普通丝线缝合组术后1个月切口瘢痕增生有17例,约占33.3%,差异无统计学意义(p=0.289)。对皮下脂肪厚度进行分层,在皮下脂肪较薄的患者中,皮下缝合组出现切口脂肪液化0例,皮下负压吸引出现切口脂肪液化1例,约占10%,两组患者切口脂肪液化率差异无统计学意义(p=0.4)。在皮下脂肪厚度中等的患者中,皮下缝合组出现切口脂肪液化6例,约占27.3%,皮下负压吸引出现脂肪液化1例,约占4.3%,两组患者切口脂肪液化率差异有统计学意义(p=0.047)。在皮下脂肪较厚的患者中,皮下缝合组出现切口脂肪液化1例,约占8.3%,皮下负压吸引组出现切口脂肪液化7例,约占29.2%,两组患者切口脂肪液化率差异无统计学意义(p=0.224)。在肝癌手术中,一次性皮肤缝合器51例患者出现切口并发症8例,均为切口脂肪液化,占约15.7%;传统丝线缝合组42例患者出现切口并发症14例,约占33.3%,其中切口脂肪液化8例,约占19%,切口感染2例,约占4.8%,切口裂开2例,约占4.8%,切口假性愈合2例,约占4.8%。两组患者的切口并发症率差异有统计学意义(p=0.038)。一次性皮肤缝合器组术后平均住院时间为13.9天,普通丝线缝合组术后平均住院时间为15天,差异无统计学意义(p=0.275);一次性皮肤缝合器组术后使用镇痛药平均3.1次,普通丝线缝合组术后使用镇痛药平均2.3次,差异无统计学意义(p=0.33);一次性皮肤缝合器组术后1个月切口瘢痕增生10例,约占19.6%,普通丝线缝合组术后1个月切口瘢痕增生17例,约占38.1%,差异有统计学意义(p=0.048)。结论在肝脏手术中,一次性皮肤缝合器与普通丝线两种皮肤缝合材料没有明显的优劣。皮下脂肪厚度中等的患者中,皮下负压吸引较皮下缝合发生脂肪液化的风险更低;在皮下脂肪较薄及较厚的患者中,皮下负压吸引与皮下缝合出现脂肪液化的风险无明显优劣。在肝癌手术中,一次性皮肤缝合器较传统的普通丝线发生切口并发症的风险更低,更具美观性,是一种安全高效的缝合材料,可以在肝癌手术中推广。
[Abstract]:A discussion on skin closure and common thread two suture materials to liver skin suture in quality, to provide guidance for the selection of the appropriate method of suture in operation. Methods we selected 106 patients from January 2016 to January 2017 in the Cancer Hospital of Guangxi Medical University liver surgery, were randomly divided into normal suture group (n=51) or disposable skin stapler group (n=55). To compare the postoperative complications rate, postoperative pain, postoperative hospitalization time and after 1 months of scar hyperplasia. Results in liver surgery, a skin suture group had 9 cases of incision complications, including incision fat accounted for about 16.4% liquefaction in 8 cases, accounted for 14.6%, 1 cases of incision dehiscence, accounted for 1.8%, 0 cases of incision infection, pseudo healing in 0 cases. The conventional suture group of incision complications in 14 cases, accounting for about 27.5% of the incision fat liquefaction in 8 cases, About 15.7%, 2 cases of incision infection, accounted for 3.9%; 2 cases of wound dehiscence, accounting for about 3.9%; pseudo healing in 2 cases, accounting for 3.9%. of two groups of patients with incision complications, the difference was not statistically significant (p=0.285). The disposable skin stapler group average postoperative hospital stay was 14.1 days, the ordinary silk thread suture group. The average hospitalization time was 14.3 days, there was no statistically significant difference (p=0.849); disposable skin stapler group postoperative analgesic use an average of 3.2 times, the ordinary silk suture group. Postoperative analgesic use an average of 2.1 times, the difference was not statistically significant (p=0.241); the disposable skin stapler group 1 months after the incision scar hyperplasia in 13 cases, accounting for about 23.6% of the ordinary silk suture group after 1 months of scar hyperplasia in 17 cases, accounting for 33.3%, the difference was not statistically significant (p=0.289). Stratification of the thickness of subcutaneous fat in the subcutaneous fat, thin patients, incision fat subcutaneous suture group Liquefaction in 0 cases, subcutaneous suction incision fat liquefaction in 1 cases, accounting for about 10%, no statistically significant difference between the two groups of patients with incision fat liquefaction rate (p=0.4) in patients with moderate thickness of subcutaneous fat, fat liquefaction of incision 6 cases subcutaneous suture group, accounting for about 27.3%, negative pressure attract subcutaneous fat liquefaction in 1 cases, accounting for about 4.3%, there were significant differences between the two groups of patients incision fat liquefaction rate (p=0.047). In a thick subcutaneous fat in patients with incision fat liquefaction in 1 cases with subcutaneous suture group, accounting for about 8.3%, subcutaneous suction group, incision fat liquid in 7 cases, accounting for about 29.2%, the difference was not statistically significant two groups of patients with incision fat liquefaction rate (p=0.224) in liver cancer surgery, disposable skin stapler in 51 patients 8 cases were incision complications, incision fat liquefaction, accounting for about 15.7%; the traditional silk suture group of 42 patients with the incision complications in 14 cases, accounting for about 3 3.3%, the incision fat liquefaction in 8 cases, accounted for 19%, 2 cases of incision infection, accounted for 4.8%, 2 cases of incision dehiscence, accounting for about 4.8% of the false incision healing in 2 cases, accounting for 4.8%. of the two groups of patients with incision complications, there was statistically significant difference (p=0.038). The disposable skin stapler group postoperative hospitalization time for 13.9 days, the ordinary silk suture group. The average postoperative hospitalization time was 15 days, there was no statistically significant difference (p=0.275); disposable skin stapler group postoperative analgesic use an average of 3.1 times, the ordinary silk suture group. Postoperative analgesic use an average of 2.3 times, the difference was not statistically significant (p=0.33); 10 cases of 1 months of scar hyperplasia disposable skin stapler group, accounting for about 19.6% of the ordinary silk suture group 1 months after surgery, the scar hyperplasia in 17 cases, accounting for 38.1%, the difference was statistically significant (p=0.048). Conclusion in liver surgery, a skin suturing device and the ordinary silk thread two The skin suture material without obvious advantages and disadvantages. Patients with moderate thickness of subcutaneous fat, subcutaneous fat suction than the subcutaneous suture in the lower risk of liquefaction; subcutaneous fat thin and thick patients, subcutaneous suction fat liquefaction risk without obvious merits with subcutaneous suture. In liver cancer operation, incision complications of disposable skin stapler than the traditional ordinary silk thread of lower risk, more beautiful, is a safe and efficient suture material can be extended in HCC patients.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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