Agarwal Akhilesh, Hossain Zahid, Agarwal Anshu, Das Amitabha, Chakraborty Saurav, Mitra Nilanjan, Gupta Madhumita, Ray Udipta
Trop Doct. 2011 Oct;41(4):193-6. doi: 10.1258/td.2011.110045. Epub 2011 Aug 10.
Midline laparotomy is an emergency surgical operation frequently performed in cases of intra-abdominal pathology. Closure of the incision is usually done by continuous suturing by mass closure. In an emergency operation the intra-abdominal milieu is usually contaminated leading to gut oedema and, hence, an increase in postoperative intra-abdominal pressure. It is complicated by wound dehiscence, burst abdomen, etc. The cause of this complication is an increase in horizontal tensile forces on the site of the insertion of sutures which cuts the sheath. In this technique of reinforced tension line suture peak tensile forces are distributed from the suture base to the surrounding tissue through a horizontal suture, thereby preventing the suture from cutting through the tissue. From July 2007 to June 2009 patients requiring laparotomy were randomly divided into test and control groups by a 'closed envelope' technique. Their postoperative intra-abdominal pressure was recorded by urinary bladder catheter manometry. The result of this technique was compared with the incidence of burst abdomen in cases where it was closed by continuous suture. A total of 190 patients underwent laparotomy. In 90 the abdomen was closed by reinforced tension line (RTL) and in 100 patients by continuous suturing. None of the RTL group had a burst abdomen. Thirteen who had closure by continuous suture had a burst abdomen. The analysis of the results was done using the chi-square test. On comparing the incidence of burst abdomen in cases operated by continuous suture technique and by RTL, the P value was found to be 0.0026 which is highly significant. On analysis of the incidence of burst abdomen in cases having a grade II intra-abdominal pressure the P value was found to be 0.0009 which is highly significant. Closure of midline incision by RTL reduces the incidence of burst abdomen. Registration No. PROVCTRI/2008/091/000269 (http://www.ctri.in).
中线剖腹术是一种常用于治疗腹腔内病变的急诊外科手术。切口通常采用连续缝合进行整块缝合关闭。在急诊手术中，腹腔内环境通常受到污染，导致肠水肿，进而使术后腹腔内压力升高。其并发症包括伤口裂开、腹壁疝等。这种并发症的原因是缝合处水平张力增加，导致缝线切割筋膜。在这种加强张力线缝合技术中，峰值张力通过水平缝线从缝线基部传递到周围组织，从而防止缝线切割组织。2007年7月至2009年6月，需要进行剖腹术的患者通过“封闭信封”技术随机分为试验组和对照组。通过膀胱导管测压记录他们术后的腹腔内压力。将该技术的结果与连续缝合关闭切口的腹壁疝发生率进行比较。共有190例患者接受了剖腹术。其中90例采用加强张力线（RTL）关闭腹部，100例采用连续缝合。RTL组无一例发生腹壁疝。13例采用连续缝合关闭的患者发生了腹壁疝。采用卡方检验对结果进行分析。比较连续缝合技术和RTL手术的腹壁疝发生率，P值为0.0026，具有高度显著性。分析腹腔内压力为II级的患者腹壁疝发生率，P值为0.0009，具有高度显著性。采用RTL关闭中线切口可降低腹壁疝的发生率。注册号：PROVCTRI/2008/091/000269（http://www.ctri.in）
