Kadirkamanathan S S, Shelton J C, Hepworth C C, Laufer J G, Swain C P
Gastrointestinal Science Research Unit, London Hospital Medical College, U.K.
J Am Coll Surg. 1996 Jan;182(1):46-54.
The strength of knots tied at laparoscopy was compared with that of hand-tied knots.
The force needed to undo or break eight types of knots that were tied in fresh postmortem human stomachs was measured. The knotting performance of nylon, polyglactin 910, braided silk, polytetrafluoroethylene, braided polyester fiber, braided polyester suture, polyamide 66, and polydiaxone was also compared.
Measurements of knot strength of two to six half hitches (hand tied) showed that four half hitches were necessary to tie a secure nonslipping knot with most monofilament threads (nylon, polytetrafluoroethylene, braided polyester suture, and polyamide 66), while three half hitches were adequate to secure a knot when polyglactin 910, braided polyester fiber, silk, and polydiaxone were used. Additional throws did not increase knot strength once the knot no longer slipped (p = NS). Some commonly tied knots, three half hitches and surgical knots at laparoscopy were weaker than the same hand-tied knots (p < 0.05) but an additional throw increased knot security (p < 0.01). Differences between laparoscopic and hand-tied knot strengths were greater for monofilament than multifilament threads. There was a wider distribution of strengths for laparoscopically tied than hand-tied knots. Four half hitches were the most secure configuration for laparoscopically tied knots and were significantly stronger than three half hitches and surgical knots (p < 0.01). The extracorporeally tied slipknot (Roeder loop) was significantly less secure than four half hitches (p < 0.05).
This study demonstrates that laparoscopically formed knots may be weaker than those tied by hand and shows that improvements in knot strength at laparoscopy can be achieved by choice of optimal knot configuration for different suture materials.
比较腹腔镜打结与手工打结的强度。
测量在新鲜的人尸体胃上所打的八种结被解开或拉断所需的力。同时比较了尼龙、聚乙醇酸910、编织丝线、聚四氟乙烯、编织聚酯纤维、编织聚酯缝线、聚酰胺66和聚二氧六环酮的打结性能。
对两到六个平结（手工打结）的结强度测量表明，使用大多数单丝缝线（尼龙、聚四氟乙烯、编织聚酯缝线和聚酰胺66）时，需要四个平结才能系成一个牢固的防滑结，而使用聚乙醇酸910、编织聚酯纤维、丝线和聚二氧六环酮时，三个平结就足以系紧一个结。一旦结不再滑动，额外的缠绕并不会增加结的强度（p = 无显著性差异）。一些常见的结，如腹腔镜下的三个平结和手术结，比相同的手工打结要弱（p < 0.05），但额外的缠绕会增加结的安全性（p < 0.01）。单丝缝线的腹腔镜打结和手工打结强度之间的差异比多丝缝线更大。腹腔镜打结的强度分布比手工打结更分散。四个平结是腹腔镜打结最牢固的构型，明显比三个平结和手术结更强（p < 0.01）。体外系的活结（罗德环）明显不如四个平结安全（p < 0.05）。
本研究表明，腹腔镜形成的结可能比手工打结弱，并表明通过为不同缝线材料选择最佳结构型，可以提高腹腔镜打结的强度。
