剖宫产皮肤切口缝合技术及处理的临床研究

卢燕玲 廖耘生 黄耀斌

【摘要】目的：探究皮肤伤口缝合技术及处理改良后应用于剖宫产的临床效果。方法：选取和睦家医院2019年1月至9月采用剖宫产皮肤切口改良的缝合技术和处理的产妇作为改良组，同时选取2018年1月至6月在广州市妇儿医院行剖宫产常规皮肤缝合技术的产妇进行对照，改良组：2/0可吸收缝线皮下脂肪间断缝合，5/0合成可吸收线进行连续皮内缝合后，加皮肤胶带减张贴合切口；对照组：2/0可吸收缝线皮下脂肪间断缝合，采用4/0合成可吸收线进行连续皮内缝合。记录产妇脂肪液化、切口感染、切口裂开、色素沉着、瘢痕增生和皮下结节等并发症情况。采用视觉模拟评分法（VAS）对剖腹产术后疼痛进行评估，并调查产妇对术后切口满意度。结果：改良组术后脂肪液化、切口感染、色素沉着、瘢痕增生及皮下结节等不良反应发生率明显低于对照组，术后疼痛评分亦低于对照组，改良组产妇对术后外观满意度高于对照组，差异有统计学意义（P<0.05）。结论：横切口剖宫产皮肤缝合技术改良处理后，临床价值显著，值得推广应用。

【关键词】剖宫产；皮肤缝合；免缝胶带

[中图分类号]R472 [文献标识码]A [文章编号]2096-5249（2021）05-0056-02

Improvement of skin suture technique for transverse incision cesarean section

LU Yan-ling， LIAO Yun-sheng， HUANG Yao-bin （1.Guangzhou United Family Hospital， Guangzhou Guangdong 510335， China； 2.Guangzhou Women and Children Medical Center， Guangzhou Guangdong 510623， China）

[Abstract] Objective： To explore the clinical effect of modified skin suture technique in transverse incision cesarean section. Methods： From January to June 2019， the inferior uterus was transected into the cesarean section. The modified group was treated with 5/0 synthetic absorbable line for continuous intradermal suture. After the skin was closed， the sutureless skin tape was reduced and fitted to the incision； the control group： the 2/0 absorbable suture subcutaneous fat was sutured intermittently， and the suture spacing was adjusted according to the length of the incision and the oozing of the fat layer， and the 4/0 synthesis was used. The absorption line is continuously sutured intradermally. Complications such as maternal fat liquefaction， wound infection， incisional cleavage， hyperpigmentation， scar hyperplasia and subcutaneous nodules were recorded. Pain after caesarean section was assessed using visual analog scale （VAS） and maternal satisfaction with postoperative incision was investigated. Results： The incidence of adverse reactions such as fat liquefaction， wound infection， pigmentation， scar hyperplasia and subcutaneous nodules in the modified group were significantly lower than that in the control group. The postoperative pain score was also lower than that in the control group. Compared with the control group， the difference was statistically significant （P<0.05）. Conclusion： The clinical value of transverse suture cesarean section suture technique is significant and worthy of popularization and application.

[Key words] cesarean section； skin suture； seam-free tape

近年来，尤其是国家二胎政策的开放以后，剖宫产的数量一直居高不下[1-2]。随着经济水平的提高和人民生活观念的改变，从以往的仅仅关注手术风险和手术安全性，到当前手术后疤痕的范围和美观，医生和产妇都越来越重视皮肤的美容縫合技术。随着认识深入，剖宫产的缝合影响的不仅仅只是伤口本身，术后的切口部位的疼痛，很大程度上影响了产妇产后早期活动，提高产妇不良情绪的发生，住院时间和医疗费用也相应增加[3]。……