缝线吻合技术在鼻内镜下泪囊鼻腔吻合术中的应用

目的 探讨鼻内镜下泪囊鼻腔吻合术（En-DCR）中应用缝线吻合技术治疗慢性泪囊炎的效果。方法 回顾性分析该院79例（79眼）慢性泪囊炎患者的临床资料,分为缝合组和无缝合组。无缝合组给予En-DCR瓣膜单纯明胶海绵固定技术,缝合组给予En-DCR瓣膜缝线吻合技术。比较两组患者的临床总有效率、术后并发症发生率、吻合口修复时间和肉芽增生等情况。结果 术后两组患者总有效率比较,差异无统计学意义（χ2=4.36,P=0.137）,并发症总发生率比较,差异无统计学意义（P=0.705）。缝合组造口黏膜上皮愈合时间短于无缝合组,差异有统计学意义（t=0.57,P=0.032）,造口肉芽增生少于无缝合组,差异有统计学意义（P=0.037）。结论 瓣膜缝线吻合并未改善其临床有效性和安全性,但可缩短造口黏膜上皮愈合时间,减少组织肉芽增生。     

多针头手术缝线在猪房间隔缺损手术模型中的应用

目的：观察新型多针头手术缝线在房间隔缺修补术中的使用效果。方法：在12个游离猪心上制作房间隔缺损模型，以涤纶补片进行修补，方法分别为间断缝合、连续缝合以及多针头手术缝线缝合。测定并比较三种缝合方法的缝合时间以及补片周围总的针孔数目，并对缝合的效果进行观察。结果：间断缝合时间明显长于连续和多针头手术缝线缝合，而后两者相比没有显著差别。差断缝合针孔数明显多于连续和多针头手术缝线缝合，后两者之间也没有显著差别。结论：多针头手术缝线是一种操作简便、使用方便快捷的手术缝线，对心肌保护有明显的优点，有良好的手术效果。     

股浅静脉壁环缝术治疗下肢深静脉瓣膜功能不全

目的：总结股浅静脉壁环缝术治疗下肢深静脉瓣膜功能不全的方法及其疗效。方法：先行大隐静脉抽剥术，解剖股浅静脉，于第一对瓣膜下用7－0无损伤缝线缝合股浅静脉壁。结果：20例患者中15例症状完全消失，5例明显缓解。结论：股浅静脉壁环缝术是治疗下肢深静脉瓣膜功能不全的有效方法之一。     

膝十字韧带移植重建术中韧带末端缝合固定强度的生物力学测试

目的 测试Krackow双锁边缝合法缝合固定韧带末端的强度，探讨膝十字韧带移植重建术中韧带末端缝合固定方法及固定强度。方法 将24条髌韧带分为3组，对其末端分别采用Krackow双锁边缝合法缝合2针、3针以及Ethilon缝线、0．4mm直径钢丝两种缝合材料，分别进行拉伸力学检测以比较强度，探讨最佳的缝合针数和方法。结果 Krackow双锁边缝合法缝合2针，固定强度超过钢丝材料强度，l号Ethilon缝线缝合两针，其强度达到80N以上，超过缝线材料强度，将第一针贯穿韧带缝合，不降低固定强度。Krackow双锁边缝合法缝合2针或3针的固定强度差异无显性意义，第一针贯穿韧带，可减少缝线裸露但不降低固定强度，均超过缝合材料强度。结论 若想增加固定强度应从改进缝合材料强度和增加缝线数目着手。     

适宜单层缝合置入的无支架猪主动脉瓣膜性能评价

背景：现有的生物瓣膜主要分为有支架和无支架两种。有支架瓣膜方便了手术操作,容易植入,植入后发生关闭不全的可能性小,但这种瓣膜并没有很好的模拟天然瓣膜。目的：为缩短瓣膜植入时间,进一步改善瓣膜性能,在参考猪主动脉根构型优化瓣膜设计的基础上,开发一种新型的适合单层缝合置入的无支架猪主动脉瓣膜,体外测试评估其性能。方法：①制备适合单层缝合的无支架猪主动脉瓣。②采用自行设计的新型单层缝合方法进行离体瓣膜植入实验。③对新型瓣膜进行体外流体力学测试及疲劳测试。结果与结论：适合单层缝合的无支架瓣膜在设计中去除了硬质的瓣架,可减轻血流冲击对瓣叶的损害,同时去除硬质瓣环后手术时可以植入口径更大的瓣膜,改善了血流动力学,较传统双层缝合瓣膜缩短了植入时间。经体外流体力学测试及疲劳测试,结果满意。但无支架生物瓣膜植入手术操作时间长、术后长期临床效果及耐久性尚需进一步临床结果验证。     

手术中缝合线的应用

缝合线（以下简称缝线）在手术中为缝合各类组织和脏器，直到手术伤口愈合为止，又可结扎缝合血管，起止血作用。所有的缝线在人体组织内均为异物，都可起不良反应，只是反应大小不同而已。选用缝线最基本的原则为：尽量使用细而拉力大、对组织反应最小的缝线。各种缝线的粗细以号数与零数表明，号数越大表示缝线越粗；零数越多表示缝线越细。医用缝线基本有以下几种：     

股浅静脉壁环缝术治疗下肢深静脉瓣功能不全

目的总结股浅静脉壁环缝术治疗下肢深静脉瓣功能不全的方法及其疗效.方法先行大隐静脉抽剥术,解剖股浅静脉,于第一对瓣膜下用7～0无损伤缝线缝合股浅静脉壁.结果20例患者中15例症状完全消失,5例明显缓解.结论股浅静脉壁环缝术是治疗下肢深静脉瓣膜功能不全的有效方法之一.     

左房顶在主动脉根部扩大成形术中的止血作用

目的：探讨在细小主动脉根部扩大成形术中一种手术止血的方法和结果。方法：11例主动脉根部扩大成形术均切开左房项，利用带垫片主动脉瓣膜缝线先穿过左房切口边缘闭合左房切口，再将邻近的左房壁向上折叠缝合于人工瓣膜水平上方的主动脉壁及人工血管补片上，覆盖并压迫主动脉根部的扩大成形切口。结果：11倒患者术中、术后均未发生出血，无手术死亡及术后心包积液，1个月后超声心动图检查，未发现主动脉瓣下有左心室向左心房分流现象。结论：在主动脉根部扩大成形术中，将左房壁向上折叠缝合覆盖并压迫主动脉根部的扩大成形切口对防止主动脉根部出血具有比较可靠的止血效果。     

皮内连续缝合不拆线法在会阴侧切术中的应用

会阴切开缝合以往常常采用肠线缝合粘膜、肌层，丝线缝合皮下脂肪、皮肤，而后者由于缝线过紧易导致组织水肿，甚至缝线嵌入组织内，给产妇带来很大痛苦。     

超声对剖宫产子宫切口单层与双层缝合切口愈合情况的对比观察

按随机原则，取剖宫产术子宫切口单层缝合80例、双层缝合50例，用二维超声对子宫切口愈合及缝线吸收情况进行定期随诊、对比观察。结果表明：术后60天缝线完全吸收率，单层缝合组为92％（74／80），双层缝合组为78％（39／50）;伤口出血及／或感染率，单层缝合组为0，双层缝合组为4％（2／50）。本文提示，剖宫产子宫切口单层缝合较双层缝合有一定的优越性。     

3种会阴切口缝合方法效果的比较

目的探讨3种不同缝合方法缝合会阴切口对产妇的影响。方法随机将760名产妇分成观察组255例、对照1组250例和对照2组255例。分别采取分层连续、传统法缝合和分层间断缝合3种方法缝合会阴切口。结果与对照1组和对照2组比较，观察组产妇伤口愈合率和术后性生活满意度高，线结反应低，差异具有统计学意义（均P〈0．05）。结论应用合成线分层连续缝合会阴切口，无线结反应，伤口疼痛轻，外表美观，不需拆线，产妇性生活满意度高。     

剖宫产横切口不同缝合法的临床应用比较

目的:寻求美观、有效、实用的剖宫产横切口皮肤缝合处理方法。方法:对820例剖腹产横切口分别采用4种皮肤缝合处理方式:(1)4/0薇乔可吸收缝线间断缝合脂肪层再以鼠齿钳钳夹皮肤5 min(A组,300例);(2)4/0薇乔可吸收缝线皮内连续缝合(B组,300例);(3)4/0薇乔可吸收缝线间断缝合脂肪再以胜康医用胶粘合皮肤(C组,120例);(4)传统丝线间断褥式缝合皮肤全层3⁵针(D组,100例)。比较4种缝合方式的愈合效果。结果:四组比较:切口甲级愈合率无显著性差别(P>0.05),伤口化脓仅在D组出现,其发生率为1.00%;缝线反应A、B、C组与D组比较,P<0.01,差别有显著性;脂肪液化D组分别与A、B、C组比较,P<0.05,差异均有显著性;皮肤对合D组分别与A、B、C组比较,P<0.05,差异均有显著性;经济比对C组价格最高,A、B组次之,D组最低。结论:4/0薇乔可吸收缝线间断缝合脂肪层再以鼠齿钳钳夹皮肤5 min可达到保持患者肌肤完美性的要求,且减轻术后痛苦及缝线等不良反应,易为患者接受,具有较好的社会效益及经济效益。     

聚羟基乙酸线全层缝合会阴侧切伤口的临床观察

本文选择1997年10月至1998年5月阴道分娩行会阴侧切缝合术产妇60例,其中用聚羟基乙酸线(2—0 DexonⅡ)全层间断缝合30例,丝线间断缝合皮肤30例,将两组分娩后伤口缝合时间、出血量及会阴疼痛情况,伤口硬结、红肿及伤口感染、裂开情况作比较,并且产后60天随访,比较伤口愈合情况,了解疼痛消失时间。结果表明:用Dexon线全层间断缝合,产后疼痛轻,伤口红肿和感染发生率均较低(P<0.05),疼痛消失时间短,瘢痕形成少。从而得出采用Dexon线全层缝合会阴侧切伤口具有多种优点,完全可代替丝线间断缝合会阴侧切伤口,值得临床推广。     

单术者心脏起搏器植入不同缝合方法的临床研究

目的对比单术者心脏永久起搏器植入术切口采用不同缝合方法的差异。方法 2011年1月—2013年10月行单术者心脏永久起搏器植入术380例,随机分为连续缝合组和间断缝合组,每组各190例,观察并比较术中两种方法切口缝合时间、术后住院时间、囊袋血肿和感染发生率及切口愈合情况。结果连续缝合组手术切口缝合时间明显短于间断缝合组,差异有统计学意义(P0.01)。术后2周两组囊袋血肿发生率及术后住院时间比较差异均无统计学意义(P0.05),且两组均无囊袋感染病例。术后3个月内连续缝合组未见皮肤线头外露,间断缝合组皮肤线头外露6例(3.16%),组间比较差异有统计学意义(P0.05);两组手术切口均愈合良好。结论单术者起搏器植入术切口应用连续缝合法具有缝合时间短、无线头外露的优势,可作为单术者起搏器植入的常规缝合方法。     

会阴侧切术采用连续缝合法的效果观察

目的：探讨连续缝合法在会阴侧切术中的应用效果。方法 选阴道分娩初产妇120例,随机分成对照组和观察组两组,各60例,均行会阴左切术。观察组用连续缝合法行会阴缝合术,对照组采用常规方法间断缝合会阴切口,两组所用缝线均为0／2可吸收线。结果 两组在缝合时间、术后疼痛时间、切口甲级愈合率和住院时间均有显性差异,均P＜0．05。结论 连续缝合法应用于会阴侧切术可明显缩短缝合时间,减轻病人术后疼痛,促进伤口愈合,从而缩短住院时间。     

单向倒刺线与普通可吸收线在腹腔镜下胆总管切开取石一期缝合术中应用的对比研究

目的评价单向倒刺线(可吸收缝合线v-locTM180)在腹腔镜下胆总管切开取石一期缝合术中应用的安全性及效果。方法回顾性分析2014年7月-2015年6月该科由同一术者主刀完成的腹腔镜下胆总管切开取石一期缝合术86例,分为倒刺线连续全层缝合胆总管组(A组)、普通可吸收线连续全层缝合胆总管组(B组)、普通可吸收线间断全层缝合胆总管组(C组)。比较各组患者胆总管缝合所需时间、术中出血量、术后进食时间、术后住院天数和术后胆瘘发生的差异。结果 86例均顺利完成腹腔镜下胆总管切开取石一期缝合手术,术中不需放置T管,无中转开腹病例。A组胆总管缝合所需时间与B、C组相比均有统计学意义(P0.05);各组两组比较在术中出血量、术后进食时间和术后住院天数方面差异无统计学意义;A组术后未出现胆瘘,B组术后胆瘘1例,C组术后胆瘘2例。结论在腹腔镜胆总管切开取石一期缝合术中,单向倒刺线连续全层缝合胆总管是操作简单、安全可行的。     

Beneficios de la sutura continua de la lesión perineal en la adaptación a la maternidad

ObjectiveTo assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic (ABVD) and instrumental (IADL), during the postpartum period.MethodsNon-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48 hours, 7-10 days and one month).Results126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n = 126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48 hours postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (P<.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (P<.001 and P<.001).ConclusionsWomen who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.     

Cost analysis of stapling versus suturing for skin closure

A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. Wound lengths, skin closure times, and the number of staples or the number and types of sutures used were recorded. Costs for materials and labor were calculated. The average total cost per case was $17.69 (with suture kit) and $7.84 (without suture kit) for the staple Group compared with $21.58 for the suture Group (P = .0001 for each). It is concluded that stapling is less costly than suturing and that the advantage appears to increase as laceration length increases.     

A surgical simulation system of skin sutures using a three-dimensional finite element method

OBJECTIVE: To establish a surgical simulation system of skin sutures using a three-dimensional finite element method. DESIGN: Three-dimensional finite element models were developed from point data obtained with a rapid three-dimensional surface-measuring device and postoperative profiles were evaluated using these models. BACKGROUND: Since suturing a wound may result in undesirable skin extrusion, it is important to make the extrusion as inconspicuous as possible. We have investigated a means of determining appropriate suture methods to decrease the extrusion. METHODS: Affected body parts were measured non-invasively with a rapid three-dimensional surface-measuring device. Finite element models were prepared, and an appropriate method for reducing skin extrusion was evaluated by attempting various suturing methods. RESULTS: Two kinds of finite element models were prepared: a conventional spindle model and a modified S-shape model. The height of the extrusion of the modified S-shape model was decreased by 40% in comparison with that of the spindle model. These results agreed with clinical findings. CONCLUSIONS: Due to this surgical simulation system of skin sutures, with a rapid three-dimensional surface-measuring device and three-dimensional finite element analysis, it was possible to design an appropriate suturing method and to evaluate the postoperative skin profiles. The modified S-shape suture method would be a recommendable method. RELEVANCE: Using this surgical simulation system of skin sutures, a surgeon can evaluate an appropriate suturing method before operation. It is expected that this system will reduce a surgeon's labor.