间断缝合与连续缝合在急诊剖腹术中的应用：一项随机对照试验。

Interrupted versus continuous fascial closure in patients undergoing emergent laparotomy: A randomized controlled trial.

机构信息

From the Department of Surgery (T.P., J.D.B., S.M., E.F., G.M.vdW., A.M., H.A., H.M.A.K., P.J.F., D.R.K., D.D.Y., G.C.V., M.A.dM.), Massachusetts General Hospital, Boston, MA.

出版信息

J Trauma Acute Care Surg. 2018 Sep;85(3):459-465. doi: 10.1097/TA.0000000000001970.

DOI:10.1097/TA.0000000000001970

PMID:29787547

Abstract

BACKGROUND

The optimal method of fascial closure, interrupted fascial closure (IFC) versus continuous fascial closure (CFC) has never been studied exclusively in the setting of emergency surgery. We hypothesized that IFC decreases postoperative incisional hernia development following emergent laparotomies.

METHODS

Between August 2008 and September 2015, patients undergoing emergent laparotomies were consented and randomly assigned to either IFC or CFC. Patients were followed up postoperatively for at least 3 months and assessed for incisional hernia, dehiscence, or wound infection. We excluded those with trauma, elective surgery, mesh in place, primary ventral hernia, previous abdominal surgery within 30 days, or those not expected to survive for more than 48 hours. Our primary endpoint was the incidence of postoperative incisional hernias.

RESULTS

One hundred thirty-six patients were randomly assigned to IFC (n = 67) or CFC (n = 69). Baseline characteristics were similar between the groups. No difference was noted in the length of the abdominal incision, or the peak inspiratory pressure after the closure. The median time needed for closure was significantly longer in the IFC group (22 minutes vs. 13 minutes, p < 0.001). Thirty-seven (55.2%) IFC and 41 (59.4%) CFC patients completed their follow-up visits. There was no statistically significant difference in baseline and intraoperative characteristics between those who completed follow-ups and those who did not. The median time from the day of surgery to the day of the last follow-up was similar between IFC and CFC (233 days vs. 216 days, p = 0.67), as were the rates of incisional hernia (13.5% versus 22.0%, p = 0.25), dehiscence (2.7% vs. 2.4%, p = 1.0), and surgical site infection (16.2% vs. 12.2%, p = 0.75).

CONCLUSION

There was no statistically detectable difference in postoperative hernia development between those undergoing IFC versus CFC after emergent laparotomies. However, this may be due to the relatively low sample size.

LEVEL OF EVIDENCE

Therapeutic/Care Management Study, level III.

摘要

背景

在急诊手术中，尚未专门研究筋膜缝合的最佳方法，即间断缝合（IFC）与连续缝合（CFC）。我们假设，IFC 可降低急诊剖腹手术后切口疝的发生。

方法

2008 年 8 月至 2015 年 9 月，征得患者同意并随机分配至 IFC 或 CFC 组。术后至少随访 3 个月，评估切口疝、裂开或伤口感染。我们排除了创伤、择期手术、有补片、原发性腹疝、30 天内有腹部手术史或预计存活时间超过 48 小时的患者。我们的主要终点是术后切口疝的发生率。

结果

136 例患者被随机分配至 IFC 组（n = 67）或 CFC 组（n = 69）。两组基线特征相似。切口长度或关腹后最大吸气压力无差异。IFC 组的中位缝合时间明显更长（22 分钟 vs. 13 分钟，p < 0.001）。37 例（55.2%）IFC 组和 41 例（59.4%）CFC 组完成了随访。完成随访者与未完成随访者在基线和术中特征方面无统计学差异。IFC 组和 CFC 组从手术日到最后一次随访的中位时间相似（233 天 vs. 216 天，p = 0.67），切口疝发生率（13.5% vs. 22.0%，p = 0.25）、裂开（2.7% vs. 2.4%，p = 1.0）和手术部位感染（16.2% vs. 12.2%，p = 0.75）亦相似。