本文選題：肝臟手術(shù)　切入點(diǎn)：肝癌　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討一次皮膚縫合器與普通絲線兩種縫合材料于肝臟手術(shù)皮膚縫合中的優(yōu)劣,為術(shù)中選擇合適的縫合方法提供指導(dǎo)。方法我們選取了2016年1月至2017年1月在廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院的肝臟手術(shù)患者106例,隨機(jī)分為普通絲線縫合組(n=51)或一次性皮膚縫合器組(n=55)。比較術(shù)后切口并發(fā)癥的發(fā)生率、術(shù)后疼痛程度、術(shù)后住院時間以及1個月后瘢痕增生等情況。結(jié)果在肝臟手術(shù)中,一次性皮膚縫合器組出現(xiàn)切口并發(fā)癥9例,約占16.4%,其中切口脂肪液化8例,約占14.6%,切口裂開1例,約占1.8%,切口感染0例,假性愈合0例。傳統(tǒng)普通絲線縫合組出現(xiàn)切口并發(fā)癥14例,約占27.5%,其中切口脂肪液化8例,約占15.7%,切口感染2例,約占3.9%;切口裂開2例,約占3.9%;假性愈合2例,約占3.9%。兩組患者切口并發(fā)癥率差異無統(tǒng)計學(xué)意義(p=0.285)。一次性皮膚縫合器組術(shù)后平均住院時間為14.1天,普通絲線縫合組術(shù)后平均住院時間為14.3天,差異無統(tǒng)計學(xué)意義(p=0.849);一次性皮膚縫合器組術(shù)后使用鎮(zhèn)痛藥平均3.2次,普通絲線縫合組術(shù)后使用鎮(zhèn)痛藥平均2.1次,差異無統(tǒng)計學(xué)意義(p=0.241);一次性皮膚縫合器組術(shù)后1個月切口瘢痕增生有13例,約占23.6%,普通絲線縫合組術(shù)后1個月切口瘢痕增生有17例,約占33.3%,差異無統(tǒng)計學(xué)意義(p=0.289)。對皮下脂肪厚度進(jìn)行分層,在皮下脂肪較薄的患者中,皮下縫合組出現(xiàn)切口脂肪液化0例,皮下負(fù)壓吸引出現(xiàn)切口脂肪液化1例,約占10%,兩組患者切口脂肪液化率差異無統(tǒng)計學(xué)意義(p=0.4)。在皮下脂肪厚度中等的患者中,皮下縫合組出現(xiàn)切口脂肪液化6例,約占27.3%,皮下負(fù)壓吸引出現(xiàn)脂肪液化1例,約占4.3%,兩組患者切口脂肪液化率差異有統(tǒng)計學(xué)意義(p=0.047)。在皮下脂肪較厚的患者中,皮下縫合組出現(xiàn)切口脂肪液化1例,約占8.3%,皮下負(fù)壓吸引組出現(xiàn)切口脂肪液化7例,約占29.2%,兩組患者切口脂肪液化率差異無統(tǒng)計學(xué)意義(p=0.224)。在肝癌手術(shù)中,一次性皮膚縫合器51例患者出現(xiàn)切口并發(fā)癥8例,均為切口脂肪液化,占約15.7%;傳統(tǒng)絲線縫合組42例患者出現(xiàn)切口并發(fā)癥14例,約占33.3%,其中切口脂肪液化8例,約占19%,切口感染2例,約占4.8%,切口裂開2例,約占4.8%,切口假性愈合2例,約占4.8%。兩組患者的切口并發(fā)癥率差異有統(tǒng)計學(xué)意義(p=0.038)。一次性皮膚縫合器組術(shù)后平均住院時間為13.9天,普通絲線縫合組術(shù)后平均住院時間為15天,差異無統(tǒng)計學(xué)意義(p=0.275);一次性皮膚縫合器組術(shù)后使用鎮(zhèn)痛藥平均3.1次,普通絲線縫合組術(shù)后使用鎮(zhèn)痛藥平均2.3次,差異無統(tǒng)計學(xué)意義(p=0.33);一次性皮膚縫合器組術(shù)后1個月切口瘢痕增生10例,約占19.6%,普通絲線縫合組術(shù)后1個月切口瘢痕增生17例,約占38.1%,差異有統(tǒng)計學(xué)意義(p=0.048)。結(jié)論在肝臟手術(shù)中,一次性皮膚縫合器與普通絲線兩種皮膚縫合材料沒有明顯的優(yōu)劣。皮下脂肪厚度中等的患者中,皮下負(fù)壓吸引較皮下縫合發(fā)生脂肪液化的風(fēng)險更低;在皮下脂肪較薄及較厚的患者中,皮下負(fù)壓吸引與皮下縫合出現(xiàn)脂肪液化的風(fēng)險無明顯優(yōu)劣。在肝癌手術(shù)中,一次性皮膚縫合器較傳統(tǒng)的普通絲線發(fā)生切口并發(fā)癥的風(fēng)險更低,更具美觀性,是一種安全高效的縫合材料,可以在肝癌手術(shù)中推廣。
[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.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 李海波;茍永勝;陳運(yùn)慶;伍星;徐琳;李蓉;;釘合與縫合技術(shù)應(yīng)用于骨科四肢骨干部位切口的療效比較[J];四川醫(yī)學(xué);2012年06期

2 楊慶菊;;皮下放置引流管預(yù)防腹壁切口脂肪液化[J];中國社區(qū)醫(yī)師(醫(yī)學(xué)專業(yè));2012年04期

3 周忠信;張思云;陳東;趙宏峰;黎東明;周杰;;腹部愈合不良切口二期縫合的處理體會[J];廣東醫(yī)學(xué);2007年10期

4 金鴻,封錦;甲狀腺手術(shù)頸部切口的美容處理[J];中華醫(yī)學(xué)美學(xué)美容雜志;2005年02期

5 韓壯,陳鵬,信守仁,馮眾一;一次性無菌皮膚縫合器的臨床應(yīng)用觀察[J];中國局解手術(shù)學(xué)雜志;1999年04期

，

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