Materials and methods
From June, 2004 to February, 2005, 200 parturients with indications of cesarean section and estimated subcutaneous fat thickness greater than 3 cm were randomly divided into two groups, aged 265,438 0 ~ 32 years. Among them, 100 cases used one-time vertical position to suture the skin fat layer (observation group), 100 cases used traditional abdominal incision suture, that is, 1 silk thread intermittently sutured subcutaneous fat, and 4 silk threads intermittently sutured the skin (control group). Surgeons are all doctors in the same group.
Anesthesia: Continuous epidural anesthesia was used in both groups.
Operation method: A new type of transverse incision cesarean section was adopted [1]. After operation, the incisions in both groups were routinely sutured to the fascia layer. Observation group: No.7 silk thread and large-angle curved needle were used to pierce the skin from the lower side of the incision 1cm, and then subcutaneous fat was extracted from the ipsilateral 1/3, then penetrated from the subcutaneous fat of the contralateral 1/3, and reached the anterior sheath of rectus abdominis at the bottom of the incision. * * * 5 stitches, leaving no dead angle at the bottom, completely stop bleeding and avoid hematoma. Control group: No.65438+No.0 silk thread intermittently sutured subcutaneous fat, No.4 silk thread intermittently stuffed skin, and * * * sewed 5 stitches. After suture, cover the incision with dressing and wrap it with abdominal belt. The same antibiotics were used to prevent infection after operation, and the dressing was changed for 3 days.
Statistical processing: the data is expressed as (x s), and the comparison between groups adopts the homogeneity test of variance (based on two-sided α=0.05), the one-way analysis of variance is used when the variance is homogeneous, and the rank sum test is used when the variance is uneven (completed by SPSS statistical software), and the counting data adopts the X2 test, with P < 0.05 indicating significant difference and P < 0.0 1 indicating very significant difference.
result
Age, weight and operation situation: There was no significant difference in age, weight and incision length between the two groups, but the total operation time and incision suture time in the observation group were significantly shorter than those in the control group, with significant differences. See table 1.
Wound healing: In the control group, there were 6 cases of fat liquefaction, including 5 cases of incision infection and incision dehiscence, 5 cases of thread head reaction, and the first-class healing rate was 89%(92 cases). There were 0 cases of fat liquefaction in the observation group, and there was no wound infection and dehiscence. The first-class healing rate was 100 cases (100%), which was significantly better than that in the control group. The observation group was basically discharged from the hospital on the 5th day after dressing change for 3 days, while the control group needed to be hospitalized due to wound fat liquefaction, and the average hospitalization time was significantly longer than that of the observation group, with a very significant difference, as shown in Table 2.
Scar condition: 42 days after operation, the scar condition of incision was followed up. In the observation group, the skin was smooth and there was no induration under the skin after the incision healed. In the control group, 6 cases of fat liquefaction, 5 cases of dye cracking and 5 cases of thread reaction were significantly greater than those in the observation group. There is no significant difference between other pregnant women's scars and the observation group, but there are induration under the skin.
discuss
The fat layer of pregnant women's lower abdomen is thick, which is easy to liquefy after operation. The traditional intermittent suture of skin and subcutaneous fat with silk thread takes a long time, which increases the chance of bacterial contamination and greatly interferes with the fat layer. After operation, the fat layer is easy to liquefy, the incision tissue is exposed for too long and dry, and the fat injury is liquefied too much. Multiple nodules can reduce the tissue resistance and create conditions for bacterial reproduction. Once the infection is changed for a long time, the wound will not heal easily without removing the stitches, and a sinus tube can be formed. Especially the incision with potential infection, such as prolonged labor and intrauterine infection, is more likely to cause skin incision infection. The internal "8" suture method reduces the above unfavorable factors, leaving no dead angle, and the suture of the fat layer is also pulled out with the skin suture when the suture is removed. This method has the advantages of skin wireless head reaction, no induration, no pain, small scar tissue, less infection, time saving during operation and good wound healing. In this paper, the observation group used intradermal continuous suture method, and no fat liquefaction occurred. The first-class cure rate is 100%, which also proves that this point is simple and feasible, and it is worth popularizing.
refer to
1 Wang Hongbin Xu Tianlan. Experience of 300 cases of cesarean section through transverse incision of abdominal wall [J]. China Medical Writing Journal, 2003, 10(9):796.