Dorsey J H, Sharp H T, Chovan J D, Holtz P M
Department of Gynecology, Greater Baltimore Medical Center, Maryland, USA.
Obstet Gynecol. 1995 Oct;86(4 Pt 1):536-40. doi: 10.1016/0029-7844(95)00243-k.
To compare the strength of laparoscopic knots with those used at laparotomy.
Three types of laparoscopic knots commonly used (Roeder, extracorporeal sliding square, and intracorporeal two-turn flat square) and three widely used conventional knots (flat square, surgeon's square, and sliding square) were tied using seven suture materials. Each knot was tied five times in random order by a single surgeon in a pelvic training model. Knot strengths were scored by tensiometer readings. A two-way analysis of variance was performed to uncover differences in mean knot strength. Turkey multiple-comparisons test was performed to determine the variability in strength of different knot geometries. Knot strength was measured in newtons.
Significant main effects for knot geometry (P < .05) and material (P < .05) as they contribute to differences in knot strength were identified, as well as an interaction for knot geometry with material (P < .05). The laparoscopic Roeder knot was significantly weaker than all other laparoscopic and conventional knots tested. The laparoscopic extracoporeal sliding square knot was significantly weaker than the conventional surgeon's square knot, and the conventional sliding square knot was significantly weaker than the conventional flat square knot and the surgeon's knot. The laparoscopic intracorporeal two-turn flat square knot was as strong as the strongest conventional knot. A significant main effect was discovered for knots with eight throws.
When performing laparoscopic procedures that result in significant tension on suture lines, consideration should be given to using the stronger laparoscopic knots, such as the intracorporeal two-turn flat square knot and the extracorporeal sliding square knot, instead of the weaker Roeder knot.
比较腹腔镜手术打结与开腹手术打结的牢固程度。
使用七种缝合材料打出三种常用的腹腔镜结（罗德结、体外滑结方结和体内双圈平结）以及三种广泛使用的传统结（平结方结、外科方结和滑结方结）。由一名外科医生在盆腔训练模型中以随机顺序将每个结各打五次。通过张力计读数对结的牢固程度进行评分。进行双向方差分析以揭示平均结牢固程度的差异。采用土耳其多重比较检验来确定不同结形状的牢固程度差异。结的牢固程度以牛顿为单位进行测量。
确定了结形状（P <.05）和材料（P <.05）对结牢固程度差异有显著的主要影响，以及结形状与材料之间的相互作用（P <.05）。腹腔镜罗德结明显弱于所有其他测试的腹腔镜结和传统结。腹腔镜体外滑结方结明显弱于传统外科方结，传统滑结方结明显弱于传统平结方结和外科结。腹腔镜体内双圈平结与最牢固的传统结一样牢固。发现打八次结有显著的主要影响。
在进行会使缝线承受显著张力的腹腔镜手术时，应考虑使用更牢固的腹腔镜结，如体内双圈平结和体外滑结方结，而不是较弱的罗德结。
