聚羟基丁酸酯可吸收缝线灭菌方法的实验研究

目的：研究不同的灭菌方法对聚羟基丁酸酯（PHB）可吸收缝线的降解性和力学特性的影响。方法：将聚羟基丁酸酯（PHB）可吸收缝线进行酒精浸泡、环氧乙烷、紫外线照射三种方法进行灭菌处理后,用细菌培养检测灭菌效果,用粘度法测定聚合物分子量从而观察缝线的降解性,用拉伸试验测定缝线的力学特性。结果：①酒精浸泡灭菌组有10%检出细菌,环氧乙烷及紫外线灭菌组未检出细菌;②紫外线照射灭菌和酒精浸泡灭菌组可使缝线黏度下降并具有显著性差异,环氧乙烷对缝线黏度下降的影响没有显著性差异;③经酒精和紫外线灭菌后缝线的断裂强度降低明显,差异具有显著性,经环氧乙烷灭菌后缝线的断裂强度降低无显著性差异。经紫外线灭菌后缝线的断裂伸长率明显降低,差异具有显著性,经酒精和环氧乙烷灭菌后缝线的断裂伸长率无明显降低。结论：环氧乙烷灭菌对PHB可吸收缝线的降解性和力学特性影响较小,是PHB可吸收缝线较理想的灭菌方法。     

聚羟基丁酸酯载体人工软骨体内培育的实验研究

目的 探讨聚羟基丁酸酶（ＰＨＢ）泡沫材料作为软骨细胞支架材料以及体内培育组织工程化人工软骨的可行性。方法 取４周龄雄性新西兰幼免关节软骨、胶原酶消化,将所获软骨细胞种植到ＰＨＢ泡沫材料上,体外培养１周后,将细胞－支架材料复合体移植到兔背背部下皮,以单纯植入聚羟基丁酸酯泡沫材料及接种软骨细胞组为对照组。分别于术后第４、８、１２周取材,进行大体观察及组织学、免疫组织化学观察。结果 软骨细胞＝支架材料复     

羟基聚磷酸钙钠与聚羟基丁酸酯膜联合修复骨缺损的实验研究

目的：评价羟基聚磷酸钙钠（Hydroxy poly-calcium nairium phosphate,HPA)与聚羟基丁酸酯膜(Polyhydroxybutyate,PHB）联合使用修复骨缺损的效果。方法：采用HPS充填狗股骨人工缺损区，同时覆盖PHB膜，与PHB膜覆盖及空白对照作比较，通过组织形态学及定量检测，考察1周，1、2、3月缺损修复情况。结果：HPA与PHB联合组，2月内骨密度及形态优于PHB组，3月后二组相当，均优于空白对照组。结论：HPA与PHB联合使用，可早期获得骨缺损修复强度与外形并举的效果。     

用可吸收MAXON缝线施行显微动脉吻合的研究

测试一种人工合成的单股可缓慢吸收的缝合材料─—聚甘醇碳酸ｐｏｌｙｇｌｙｃｏｎａｔｅ，Ｍａｘｏｎ缝线─—以判断其是否合用于显微外科的无张力下和张力下动脉吻合。用８－０Ｍａｘｏｎ缝线吻合外径平均０．６３ｍｍ的大白鼠股动脉３４次，即时通畅率为１００％，吻合后１一２４周的晚期通畅率为９４．１％。在３０次外径平均１．４３ｍｍ的家兔股动脉切除其游离段约１／３段长度后，用８－０Ｍａｘｏｎ缝线在张力下吻合后，即时通畅率为１００％，１～２４周后通畅率为９６．７％。形态学研究包括光学显微镜和扫描电子显微镜检查。结果显示Ｍａｘｏｎ缝线能保持较长时间的张力强度，足以支持血管的愈合，并且只引起较轻的组织反应。在血管壁完全再生后缝线材料才完全吸收。这些结果证示可吸收的Ｍａｘｏｎ缝线可适合于在一般张力下和在相当程度的张力下施行动脉显微血管吻合之用。     

羟基聚磷酸钙钠与聚羟基丁酸酯膜联合修复骨缺损的实验研究

目的 评价羟基聚磷酸钙钠(Hydroxy poly-calcium nairium phosphate,HPA)与聚羟基丁酸酯(Polyhydroxybutyrate,PHB)联合使用修复骨缺损的效果。方法 采用HPA充填狗股骨人工缺损区,同时覆盖PHB膜,与PHB膜覆盖及空白对照作比较,通过组织形态学及定量检测,考察1周,1、2、3月缺损修复情况。结果 HPA与PHB联合组,2月内骨密度及形态优于PHB组,3月后二组相当,均优于空白对照组。结论 HPA与PHB联合使用,可早期获得骨缺损修复强度与外形并举的效果。     

可吸收缝线加记忆合金聚髌器治疗髌骨粉碎性骨折

2003年1月～2008年6月,我科应用记忆合金聚髌器加可吸收缝线治疗髌骨粉碎性骨折35例,疗效满意。     

可吸收缝线在小儿心血管外科的应用

可吸收缝线在小儿心血管外科的应用王顺民综述苏肇伉审校在小儿先天性心脏病的手术治疗中，传统的自身血管吻合是用单丝非吸收缝线来完成的［１］。但越来越多的临床及动物实验表明，单丝非吸收缝线如ｐｒｏｌｅｎｅ（ｐｏｌｙｐｒｏｐｙｌｅｎｅ聚丙烯）应用于血管吻合时...     

聚-β-羟基丁酸酯提取方法的比较

报道了一种从真养产碱杆菌中提取聚－β－羟基丁酸酯的新方法，并将其与其它几种提取方法进行了比较。研究了各种提取方法对聚－β－羟基丁酸酯的纯度、提取率及摩尔质量的影响。结果表明，用有机溶剂在丙酮预处理后回流提取，聚－β－羟基丁酸酯的纯度达９７％以上，摩尔质量Ｍ＝３３０ｋｇ／ｍｏｌ左右，但提取率仅约７０％；用次氯酸钠提取时，纯度９０％，提取率８８％，但Ｍ只有２１６ｋｇ／ｍｏｌ，比起始菌体中的４０２ｋｇ／ｍｏｌ降低近一半；用分散的氯仿－次氯酸钠提取，聚－β－羟基丁酸酯纯度９７％，提取率８２％，Ｍ＝３１０ｋｇ／ｍｏｌ；酶法提取的纯度只有８５％；而用新发明的表面活性剂－络合剂法，聚－β－羟基丁酸酯纯度９８．７％，提取率达９３．３％，Ｍ＝３１６ｋｇ／ｍｏｌ．     

聚羟基丁酸酯复合骨髓基质细胞构建组织工程骨修复兔下颌骨缺损

目的：探讨以聚羟基丁酸酯（PHB）作为骨组织工程支架的可行性.方法：体外培养兔骨髓基质细胞（BMSCs）,使其向成骨细胞分化后接种于PHB支架上,植入兔下颌角骨缺损中,以单纯缺损、单纯植入材料、植入新鲜骨髓加材料作为对照.4、8、1 2、24周分别处死各组家兔2只,行大体标本、X线摄片、组织学及扫描电镜观察新骨形成情况.结果：实验组24周大部分材料被骨性组织取代,修复骨缺损效率较对照组高.结论：PHB可以作为组织工程材料中的一种来修复骨缺损.     

残耳软骨细胞种植于聚羟基丁酸酯-聚羟基己酸酯共聚物形成组织工程软骨

目的探讨以聚羟基丁酸酯-聚羟基己酸酯(PHB-PHH)共聚物为细胞外支架、以残耳软骨作为种子细胞形成组织工程软骨的可能性。方法取先天性小耳畸形8例患者的残耳软骨，以胶原酶消化后种植于PHBPHH支架，体外培养1周后种植于8只裸鼠一侧背部皮下为实验组，另一侧只植入支架材料作为对照组。于4周、8周后取出标本，做大体观察及HE染色、Masson三色染色检查。结果4周时实验组镜下显示有新生软骨形成，但仍有部分支架材料残留；8周时实验组标本大体观察及HE染色、Masson三色染色检查新生软骨与人耳软骨相似，支架材料已完全吸收。对照组无软骨形成。结论以残耳软骨作为种子细胞，以PHB-PHH共聚物为细胞外支架可以形成组织工程软骨，新生软骨大体观察、组织学检查与人耳软骨相似。     

膝关节置换术中可吸收倒刺缝线与常规可吸收缝线缝合切口的效果比较

目的比较初次全膝关节置换术(total knee arthroplasty,TKA)中可吸收倒刺缝线与常规可吸收缝线缝合切口的临床效果。方法本研究回顾性地选取2017年1月至2018年12月我科收治的80例TKA病人为研究对象,2017年1～12月使用常规可吸收缝线间断缝合关节囊的40例病人纳入对照组,2018年1～12月采用可吸收倒刺缝线连续缝合关节囊的40例病人纳入观察组,比较两组的切口缝合时间、手术时间、拆线时间、住院时间和术后切口并发症发生率等指标的差异,收集两组术后切口疼痛、肿胀、活动度等一般情况及Lysholm膝关节功能评分。结果观察组的切口缝合时间和手术时间分别为(8.02±2.15)min、(65.05±9.15)min,明显少于对照组的(20.45±2.65)min、(94.45±5.28)min,两组相比,差异均有统计学意义(P均<0.05),但两组病人的拆线时间、住院时间比较,差异均无统计学意义(P均>0.05)。观察组的切口总并发症发生率、轻微并发症发生率和严重并发症发生率分别为17.5%、15.0%、2.5%,对照组分别为7.5%、7.5%、0,两...     

Quilltm可吸收线与薇乔线在腹腔镜保留肾单位手术中的应用比较（附视频）

目的评价Quilltm可吸收线在腹腔镜保留肾单位手术（LNSS）的临床疗效。方法回顾分析同一时期腹腔镜下保留肾单位手术中15例采用Quilltm可吸收线（Quill组）和13例采用微乔可吸收线及Hem-o—lok（对照组）的临床资料,比较两种方法的手术时间、失血量、热缺血时间及肾实质缝合材料费用的差异。结果Quill组和对照组平均手术时间分别为（126．9±35．9）和（138．2±26．7）min（P〉0．05）,平均失血量分别为（147．5±42．9）和（161．3±54．8）ml（P〉0．05）,差异无统计学意义。平均热缺血时间分别为（24．1±3．8）和（27．4±3．1）min（P〈0．05）,肾实质缝合材料平均费用分别为（1289．3±309．7）和（2409．2±336．7）ml（P〈0．01）,差异有统计学意义。所有患者术后均无继发出血、感染或漏尿。结论LNSS采用Quilltm可吸收线安全可靠,在减少术中热缺血时间、节约医疗费用方面,优于普通缝合材料。     

Use of adhesive surgical tape with the absorbable continuous subcuticular suture

Background: The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. Methods: Review was undertaken of the medical literature using the PubMed Internet database and cross‐referencing major ­articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op‐site, staples, subcuticular suture, complication, infection and scars. Results: Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. Conclusions: There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.     

单向可吸收倒刺线与PDS-II缝线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用及对比分析

目的 探讨单向可吸收倒刺线与PDS-II缝线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用价值。方法采用回顾性队列研究方法,收集2017年1月至2020年6月内江市第二人民医院收治的60例行腹腔镜胰十二脂肠切除术患者的临床资料,其中30例患者胆肠吻合时采用单向可吸收倒刺线,设为倒刺线组;另30例患者胆肠吻合时采用PDS-II缝线,设为PDS-II组。观察两组手术时间、术中出血量、肝总管直径、胆肠吻合口内径和术后并发症情况。结果 （1）术中情况：两组患者均完成腹腔镜根治性胰十二指肠切除术,胆肠吻合均采用横结肠后Roux-en-Y吻合方式,均未放置T管引流,无姑息性胆肠吻合减黄。与PDS-II组比较,倒刺线组胆肠吻合手术时间缩短[（13.2±8.1）min vs（15.8±7.6）min],差异有统计学意义（P＜0.05）,但术中出血量[（80±8）mL vs（94±5）mL]、肝总管直径[（1.5±0.6）cm vs（1.3±0.8）cm]、胆肠吻合口内径[（1.3±0.8）cm vs（1.1±0.6）cm],两组差异均无统计学意义（P＞0.05）。（2）术后情况：与PDS-II组比较,倒刺线组患者术后胆漏[0例（0）vs 3例（10%）]、术后胆肠吻合口后方引流管拔出时间[（3.8±0.9）d vs（7.2±0.3）d]、术后住院时间[（7.8±0.9）d vs（10.2±0.6）d]均降低,差异有统计学意义（P＜0.05）。（3）随访情况：60例患者均获得随访,随访时间6～12个月,中位随访时间8个月,与PDS-II组比较,倒刺线组患者术后胆肠吻合口狭窄[2例（6.7%）vs 5例（16.7%）]和狭窄胆肠吻合口拆除再吻合发生率下降[0例（0）vs 3例（10%）],差异有统计学意义（P＜0.05）。术后反流性胆道感染发生率[2例（6.7%）vs 3例（10.0%）],差异无统计学意义（P＞0.05）。结论 单向可吸收倒刺线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用是安全、有效的,能够减少胆肠吻合口狭窄及胆漏的发生率。     

Facilitating the technique of laparoscopic running urethrovesical anastomosis using Lapra-ty absorbable suture clips

We herein describe a simplified technique for performing laparoscopic running urethrovesical anastomosis using Lapra-ty absorbable suture clips (Ethicon, Somerville, NJ, USA) during a laparoscopic radical prostatectomy (LRP). Using two 20 cm absorbable sutures tied together and locked with Lapra-ty at their tail ends, the initiating mattress sutures are placed in the 5:30-6:30-o'clock area between the urethra and the bladder neck. The left and right running sutures are then made clockwise from the 6:30-12-o'clock position and counterclockwise from the 5:30-12-o'clock position, respectively. Both sutures are locked with proper tension by Lapra-ty at the 3, 9 and 12-o'clock positions, and then they are intracorporeally tied together just at the 12-o'clock position. In the initial 20 cases, this anastomosis took 22.5 min on average to perform. We experienced no major urine extravasation and no anastomotic stricture to date.     

Coated polyglactin 910—A new synthetic absorbable suture

Physical properties of newly developed synthetic absorbable sutures, “coated polyglactin 910”, were compared with findings in two conventional synthetic absorbable sutures. Clinical results of application in 108 cases in Japan (123 clinical cases in number of tissues approximated) were also evaluated. Our findings clearly indicate that coated polyglactin 910 sutures may well become the sutures of choice for various surgical applications.     

可吸收缝线缝合固定法治疗胫骨髁间嵴撕脱性骨折

我科1998年6月-2002年12月，采用Maxon可吸收缝线作前交叉韧带基底部Bunnell缝合固定法治疗胫骨髁间嵴撕脱性骨折22例，取得了满意的疗效，现报告如下。     

可吸收缝线联合克氏针固定治疗腱性锤状指

2017 年6 月 ～2018 年12 月,我科采用可吸收缝线联合克氏针固定治疗16例腱性锤状指患者,疗效满意,报道如下. 1 材料与方法 1. 1 病例资料 本组16 例,男12 例,女4 例,年龄 21 ～53 岁.开放损伤 2例,闭合损伤14例.受伤至手术时间1 h～8d.     

Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture

Background  The upsurge of gastric bypass procedures has been accompanied by an increase in anastomotic strictures and marginal ulcers. According to the reported literature, the gastrojejunostomy strictures in 3–31% and ulcerates in 1–16% of cases. Several anastomotic techniques are used, however no study has specifically addressed whether choice of reinforcing suture affects rates of stricture or ulcer. We reviewed our case series to determine if a protocol change in suture choice altered the incidence of anastomotic strictures and marginal ulcers. Methods  We performed a retrospective review of a prospectively collected database for 315 primary Roux-en-Y gastric bypass patients (7/2008 to 3/2008). Nearly all patients had a 25-mm circular stapled anastomosis with an outer suture layer for reinforcement. Before 5/31/06, interrupted permanent suture was used in 231 patients, and after 6/1/06 interrupted absorbable suture was used in 84 patients. We compared overall rates of stricture, marginal ulceration, and aggregate gastrojejunostomy complications between the two suture groups using a proportional hazards model and log-rank statistic. A p-value < 0.05 was used to assign statistical significance. Results  We found statistically fewer gastrojejunostomy complications in the absorbable suture group (4.7%) than the permanent suture group (19.9%). Subgroup analysis showed that anastomotic strictures were less common in the absorbable suture group, but the difference was short of statistical confirmation. Use of absorbable suture did result in statistically fewer marginal ulcers (2.3%) compared with absorbable suture (13.4%). Conclusions  Use of absorbable reinforcing sutures is associated with fewer gastrojejunostomy complications. We recommend absorbable sutures for the outer layer of stapled gastrojejunal anastomoses when performing isolated Roux-en-Y gastric bypass.