Soisson A P, Olt G, Soper J T, Berchuck A, Rodriguez G, Clarke-Pearson D L
Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina 27710.
Gynecol Oncol. 1993 Dec;51(3):330-4. doi: 10.1006/gyno.1993.1299.
The objective of this prospective study was to determine the efficacy of subcutaneous retention sutures in the prevention of superficial wound separation in obese women undergoing gynecologic surgery. From 1985 to 1990, 80 women with subcutaneous tissue of 5 cm or greater undergoing laparotomy were randomly assigned to either standard wound closure (37 patients) or closure including subcutaneous retention sutures (43 patients). We examined the relationship of the following factors to the development of superficial wound dehiscence: malnutrition (total protein < 6.0 mg/dl, albumin < 3.0 mg/dl), minidose heparin (5000 U subcutaneously every 8 hr for 5 days), diabetes mellitus, prolonged operative time (> 180 min), intraoperative spillage of enteral contents, and subcutaneous retention sutures. In a univariate analysis, malnutrition (P = 0.02), the use of heparin (P = 0.03), and the absence of retention sutures (P = 0.02) were associated with an increased risk of separation. In a multivariate analysis, malnutrition (P = 0.02), low-dose heparin (P = 0.03), and the absence of retention sutures (P = 0.04) retained their independent association with superficial wound separation. This study suggests that the use of subcutaneous retention sutures reduces the incidence of superficial wound separation in obese women undergoing gynecologic surgery.
这项前瞻性研究的目的是确定皮下留置缝线在预防接受妇科手术的肥胖女性浅表伤口裂开方面的疗效。1985年至1990年，80名皮下组织厚度达5厘米或更厚且接受剖腹手术的女性被随机分为标准伤口缝合组（37例患者）或包括皮下留置缝线的缝合组（43例患者）。我们研究了以下因素与浅表伤口裂开发生之间的关系：营养不良（总蛋白<6.0mg/dl，白蛋白<3.0mg/dl）、小剂量肝素（每8小时皮下注射5000U，共5天）、糖尿病、手术时间延长（>180分钟）、术中肠内容物溢出以及皮下留置缝线。在单因素分析中，营养不良（P=0.02）、肝素的使用（P=0.03）以及未使用留置缝线（P=0.02）与伤口裂开风险增加相关。在多因素分析中，营养不良（P=0.02）、低剂量肝素（P=0.03）以及未使用留置缝线（P=0.04）与浅表伤口裂开仍保持独立相关性。本研究表明，皮下留置缝线的使用可降低接受妇科手术的肥胖女性浅表伤口裂开的发生率。
