龚逞英 罗序清 廖凤娇

【摘要】 目的：探討无创皮肤吻合器联合心形缝合皮下脂肪对腹部瘢痕的影响。方法：回顾性分析2021年1月—2022年9月于新余市妇幼保健院行剖宫产手术的120例患者的病历资料，将接受无创皮肤吻合器联合心形缝合的60例患者纳入A组，将接受无创皮肤吻合器联合传统美容缝合的60例患者纳入B组，两组出院后均随访6个月。比较两组切口缝合时间、切口愈合时间及住院时间，术后24 h、72 h、7 d切口疼痛[视觉模拟评分法（VAS）]，术后1个月切口愈合情况、切口并发症发生率，术后6个月切口瘢痕情况[温哥华瘢痕评定量表（VSS）]、缝合效果满意度。结果：两组切口缝合时间差异无统计学意义（P>0.05），A组切口愈合时间与住院时间均短于B组，差异均有统计学意义（P<0.05）；两组术后24 h、72 h VAS评分差异均无统计学意义（P>0.05），A组术后7 d VAS评分低于B组，差异有统计学意义（P<0.05）；术后1个月，A组伤口愈合等级优于B组，A组切口并发症总发生率低于B组，差异均有统计学意义（P<0.05）；术后6个月，A组VSS评分低于B组，A组缝合效果满意度高于B组，差异均有统计学意义（P<0.05）。结论：无创皮肤吻合器联合心形缝合皮下脂肪在剖宫产患者中应用价值高，能有效促进术后患者腹部切口愈合，减少术后疼痛，降低切口并发症发生及瘢痕增生风险，并获得更高的患者满意度。

【关键词】 无创皮肤吻合器 心形缝合 腹部瘢痕 剖宫产手术

Effect of Noninvasive Skin Stapler Combined with Heart-shaped Suture of Subcutaneous Fat on Abdominal Scar/GONG Chengying， LUO Xuqing， LIAO Fengjiao. //Medical Innovation of China， 2024， 21（08）： 0-064

[Abstract] Objective： To explore the effect of noninvasive skin stapler combined with heart-shaped suture of subcutaneous fat on abdominal scar. Method： The medical records of 120 patients who underwent cesarean section in Xinyu Maternal and Child Health Care Hospital from January 2021 to September 2022 were retrospectively analyzed. Sixty patients who received noninvasive skin stapler combined with heart-shaped suture were included in group A， and 60 patients who received noninvasive skin stapler combined with traditional cosmetic suture were included in group B， both groups were followed up for 6 months after discharge. Incision suture time， incision healing time and hospital stay， incision pain at 24 h， 72 h and 7 d after surgery [visual analogue scale （VAS）]， incision healing， incidence of incision complications at 1 month after surgery， incision scar at 6 months after surgery [Vancouver scar rating scale （VSS）]， and satisfaction with suture effect were compared between the two groups. Result： There was no statistically significant difference in incision suture time between the two groups （P>0.05）. The incision healing time and hospital stay in group A were shorter than those in group B， the differences were statistically significant （P<0.05）. There were no statistical differences in VAS scores at 24 h and 72 h after surgery between the two groups （P>0.05）， and the VAS score at 7 d after surgery in group A was lower than that in group B， the difference was statistically significant （P<0.05）. 1 month after surgery， the wound healing grade of group A was better than that of group B， and the total incidence of incision complications in group A was lower than that in group B， the differences were statistically significant （P<0.05）. The VSS score in group A at 6 months after surgery was lower than that in group B， and the satisfaction of suture effect in group A was higher than that in group B， the differences were statistically significant （P<0.05）. Conclusion： Noninvasive skin stapler combined with heart-shaped suture of subcutaneous fat has high application value on patients with cesarean section， and it can effectively promote the postoperative abdominal incision healing， relieve the postoperative pain， reduce the occurrence of incision complications and scar hyperplasia risk， and obtain high patient satisfaction.

[Key words] Noninvasive skin stapler Heart-shaped suture Abdominal scar Caesarean section

First-author's address： Department of Obstetrics， Xinyu Maternal and Child Health Care Hospital， Xinyu 338000， China

doi：10.3969/j.issn.1674-4985.2024.08.014

剖宫产是产科的重要术式，随着麻醉与外科手术技术的不断提升，该术式已在我国广泛运用[1]。对腹部皮下脂肪的处理是手术的最后步骤，因为腹部脂肪层较厚，若处理缝合不当不仅易导致切口愈合不良，还可能导致患者出现切口脂肪液化、开裂等不良事件[2]。若缝合质量不过关，真皮内可能会存留线结等异物，导致伤口愈合不良，再加上剖宫产手术切口张力较大，使得切口易出现瘢痕增生，不仅会降低患者美观，还易导致其切口处出现紧绷、疼痛等不适[3]。心形缝合通过分层缝合，能有效减少伤口无效腔残留，促进伤口愈合，同时能避免缝线外露对皮肤产生压力，减少瘢痕增生[4]。无创……