Gislason H, Grønbech J E, Søreide O
Department of Surgery, University of Bergen, Haukeland Hospital, Norway.
Eur J Surg. 1995 May;161(5):349-54.
To compare the incidence of burst abdomen and incisional hernia after three different techniques of closure of the abdominal wall after major gastrointestinal operations.
Prospective, randomised, controlled trial.
University hospital, Norway.
599 adults who underwent major operations for gastrointestinal conditions between December 1990 and February 1992.
Patients were randomised in three groups for abdominal wall closure by continuous mass polyglyconate (Maxon) double suture with loop, continuous mass polyglactin 910 (Vicryl), and interrupted polyglactin 910 (Vicryl) (layered for transverse and mass for midline incisions).
Burst abdomen during the postoperative period, and incisional hernia after one year follow up.
The incidence of wound dehiscence was 2% and of incisional hernia at one year 7%. There were no differences in the rate of dehiscence among the groups, but there were significantly more hernias in the polyglyconate group (19/164, 12%) compared with the two in which polyglactin 910 was used (16/327, 5%). Wound infections developed in 84/583 of our patients (14%) and the incidence was closely associated with emergency operations and contamination. Wound complications were not associated with the closure technique.
Wound infection is the most important single factor in the development of burst abdomen and incisional hernia. The continuous closure technique is quicker, cheaper, and as safe as the interrupted technique.
比较三种不同的胃肠道大手术后腹壁关闭技术术后切口裂开和切口疝的发生率。
前瞻性、随机、对照试验。
挪威大学医院。
1990年12月至1992年2月期间接受胃肠道疾病大手术的599名成年人。
将患者随机分为三组，分别采用连续聚甘醇酸（Maxon）双缝合法带环缝闭腹壁、连续聚乳酸910（Vicryl）缝闭腹壁和间断聚乳酸910（Vicryl）缝闭腹壁（横行切口分层缝闭，正中切口连续缝闭）。
术后切口裂开情况，以及随访一年后的切口疝情况。
伤口裂开发生率为2%，一年后切口疝发生率为7%。各组之间的裂开率没有差异，但聚甘醇酸组的疝发生率显著高于使用聚乳酸910的两组（19/164，12%对比16/327，5%）。84/583例患者发生了伤口感染（14%），其发生率与急诊手术和污染密切相关。伤口并发症与关闭技术无关。
伤口感染是切口裂开和切口疝发生的最重要单一因素。连续缝闭技术更快、更便宜，且与间断缝闭技术一样安全。
