改良垂直埋没褥式缝合在乳房切口中的应用效果观察
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摘要
目的:探讨改良垂直埋没褥式缝合在乳房切口缝合中的应用效果。方法:收集2017年4月-2017年9月以"乳腺包块"就诊的患者资料,以手术切口为研究对象,根据缝合方式不同分成两组,BIS组行皮内埋没缝合(buried intradermal suture,BIS),WE-MBVMS组行楔形切除结合改良埋没垂直褥式缝合(wedge-shaped excision and modified buried vertical mattress suture,WE-MBVMS),分析对比两组的基本信息、术后切口即刻的外貌特征、随访期间的并发症发生率以及术后3个月的瘢痕评分状况。结果:最终纳入患者共92例,切口96个。两组患者均为亚洲女性,均无抽烟及酗酒史,术后病理显示均为良性包块,年龄层次、切口长度及部位比较,差异无统计学意义(P>0.05)。WE-MBVMS组术后即刻外翻高度(4.65±0.92)mm明显大于BIS组(0.98±0.55)mm,差异有统计学意义(P<0.05)。WE-MBVMS组并发症发生率为2.2%(1/46)低于BIS组(8.0%,4/50),但组间比较差异无统计学意义(P>0.05)。POSAS评分及VSS评分显示,WE-MBVMS较BIS可获得更好的满意度,WE-MBVMS较BIS可获得更窄的瘢痕,差异有统计学意义(P<0.05)。但两组VAS评分比较,差异无统计学意义(P>0.05)。结论:WE-MBVMS可更好地实现切口外翻,术后3个月的瘢痕评价优于BIS,故WE-MBVMS在乳房切口的应用可获得更令人满意的愈合效果。
Objective The purpose of the study is to compare the cosmetic results of WE-MBVMS with the BIS in mammary incisions. Methods The clinical information were collected from those patients who had mammary gland tumors and had received treatment from hospital during April 2017 to September 2017. Incisions after the lumpectomy were selected as research objects. After sorting all of information into two groups by different suture techiques, WE-MBVMS or BIS, the compared parameters will be the basic information of patients, the maximum degree of incision eversion achieved immediately postoperatively, complication rates, and the scores of the scar over the 3-month follow-up period. Results Finally 92 patients and 96 incisions had been made a detailed analysis. Both groups of patients were Asian women and had no history of smoking and alcoholism. The pathological results of lumps were benign. There was no significant difference in age, incision length and location between the two groups(P>0.05). The height of valgus in WE-MBVMS group was(4.65±0.92)mm immediately after operation,which was significantly higher than that in BIS group(0.98±0.55)mm, the difference was statistically significant(P<0.05). The incidence of complications in WE-MBVMS group was 2.2%(1/46) lower than that in BIS group(8.0%, 4/50), but there was no significant difference between the two groups(P>0.05). Total POSAS and VSS scores in WE-MBVMS group were significantly lower than those in BIS group(P<0.05). The width of scar in WE-MBVMS group was significantly lower than that in BIS group(P<0.05). However, there was no significant difference in VAS score between the two groups(P>0.05). Conclusion The WEMBVMS provided superior wound eversion and better aesthetic outcomes than the BIS,and deserved clinical promotion.
Objective The purpose of the study is to compare the cosmetic results of WE-MBVMS with the BIS in mammary incisions. Methods The clinical information were collected from those patients who had mammary gland tumors and had received treatment from hospital during April 2017 to September 2017. Incisions after the lumpectomy were selected as research objects. After sorting all of information into two groups by different suture techiques, WE-MBVMS or BIS, the compared parameters will be the basic information of patients, the maximum degree of incision eversion achieved immediately postoperatively, complication rates, and the scores of the scar over the 3-month follow-up period. Results Finally 92 patients and 96 incisions had been made a detailed analysis. Both groups of patients were Asian women and had no history of smoking and alcoholism. The pathological results of lumps were benign. There was no significant difference in age, incision length and location between the two groups(P>0.05). The height of valgus in WE-MBVMS group was(4.65±0.92)mm immediately after operation,which was significantly higher than that in BIS group(0.98±0.55)mm, the difference was statistically significant(P<0.05). The incidence of complications in WE-MBVMS group was 2.2%(1/46) lower than that in BIS group(8.0%, 4/50), but there was no significant difference between the two groups(P>0.05). Total POSAS and VSS scores in WE-MBVMS group were significantly lower than those in BIS group(P<0.05). The width of scar in WE-MBVMS group was significantly lower than that in BIS group(P<0.05). However, there was no significant difference in VAS score between the two groups(P>0.05). Conclusion The WEMBVMS provided superior wound eversion and better aesthetic outcomes than the BIS,and deserved clinical promotion.
引文
[1]段利军.乳腺良性包块手术切除后并发症的防治[J].临床合理用药杂志,2014,7(10):16-17.
[2]段学宁.乳腺良性疾病诊治共识与争议[J].中国实用外科杂志,2016,11(7):713-715.
[3]李杨.乳房应用美学与乳房多位点、多类型微创化手术的临床应用研究[D].长春:吉林大学,2012.
[4]Khansa I,Harrison B,Janis JE.Evidence-based scar management[J]Plast Reconstr Surg,2016,138:165S-178S.
[5]Regula CG,Yag-Howard C.Suture products and techniques[J]Dermatol Surg,2015,41(Suppl 10):S187-S200.
[6]Yag-Howard C.Sutures,needles,and tissue adhesives:a review for dermatologic surgery[J].Dermatol Surg,2014,40(Suppl 9):S3-S15.
[7]Zhang X,Diao J,Guo S,et al.Wedge-shaped excision and modified vertical mattress suture fully buried in a multilayered and tensioned wound closure[J].Aesthetic Plast Surg,2009,33(3):457-460.
[8]张志愿.口腔颌面外科学[M].7版.北京:人民卫生出版社,2012:39-43.
[9]李世荣.现代整形美容外科学[M].北京:人民军医出版社,2014:251-252.
[10]Branham G.Thomas面部美容整形:面部软组织整形[M].北京:人民卫生出版社,2017:27-29.
[11]Thompson CM,Sood RF,Honari S,et al.What score on the Vancouver Scar Scale constitutes a hypertrophic scar?Results from a survey of North American burn-care providers[J].Burns,2015,41(7):1442-1448.
[12]Duncan JAL,Bond JS,Mason T,et al.Visual analogue scale scoring and ranking:a suitable and sensitive method for assessing scar quality?[J].Plast Reconstr Surg,2006,118(4):909-918.
[13]van de Kar AL,Corion LUM,Smeulders MJC,et al.Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale[J].Plast Reconstr Surg,2005,116(2):514-522.
[14]Draaijers LJ,Tempelman FRH,Botman YAM,et al.The patient and observer scar assessment scale:a reliable and feasible tool for scar evaluation[J].Plast Reconstr Surg,2004,113(7):1960-1965.
[15]刘宗辉,舒茂国,刘翔宇.整形外科皮肤缝合技术的特点及应用[J].中国美容医学,2017,26(7):136-139.
[16]Moody BR,McCarthy JE,Linder J,et al.Enhanced cosmetic outcome with running horizontal mattress sutures[J].Dermatol Surg,2005,31(10):1313.
[17]Wang AS,Kleinerman R,Armstrong AW,et al.Set-back versus buried vertical mattress suturing:Results of a randomized blinded trial[J].JAm Acad Dermatol,2015,72(4):674-680.
[18]Yang J,Kim KH,Song YJ,et al.Cosmetic outcomes of cesarean section scar;subcuticular suture versus intradermal buried suture[J].Obstet Gynecol Sci,2018,61(1):79.
[19]Koonce SL,Eck DL,Shaddix KK,et al.A prospective randomized controlled trial comparing N-butyl-2 cyanoacrylate(Histoacryl),octyl cyanoacrylate(Dermabond),and subcuticular suture for closure of surgical incisions[J].Ann Plast Surg,2015,74(1):107-110.
[20]Blondeel PN,Richter D,Stoff A,et al.Evaluation of a new skin closure device in surgical incisions associated with breast procedures[J].Ann Plast Surg,2014,73(6):631-637.
[21]Richter D,Stoff A,Ramakrishnan V,et al.A comparison of a new skin closure device and intradermal sutures in the closure of full-thickness surgical incisions[J].Plast Reconstr Surg,2012,130(4):843-850.
[22]Parvizi D,Friedl H,Schintler MV,et al.Use of 2-octyl cyanoacrylate together with a self-adhering mesh(Dermabond Prineo)for skin closure following abdominoplasty:an open,prospective,controlled,randomized,clinical study[J].Aesthetic Plast Surg,2013,37(3):529-537.
[23]Regan T,Lawrence N.Comparison of poliglecaprone-25 and polyglactin-910in cutaneous surgery[J].Dermatol Surg,2013,39(9):1340-1344.
[24]Kang X,Zhao L,Leung F,et al.Delivery of instructions via mobile social media app increases quality of bowel preparation[J].Clin Gastroenterol Hepatol,2016,14(3):429-435.
[25]Son D,Harijan A.Overview of surgical scar prevention and management[J].J Korean Med Sci,2014,29(6):751-757.
[26]Zide MF.Scar revision with hypereversion[J].J Oral Maxillofac Surg,1996,54(9):1061-1067.
[27]Alam M,Goldberg LH.Utility of fully buried horizontal mattress sutures[J].J Am Acad Dermatol,2004,50(1):73-76.
[28]Quinn J,Wells G,Sutcliffe T,et al.Tissue adhesive versus suture wound repair at 1 year:randomized clinical trial correlating early,3-month,and1-year cosmetic outcome[J].Ann Emerg Med,1998,32(6):645-649.
[29]Park YJ,Kim SJ,Song HS,et al.Prevention of thyroidectomy scars in Asian adults with low-level light therapy[J].Dermatol Surg,2016,42(4):526-534.
[30]Simforoosh N,Abedi A,Hosseini Sharifi SH,et al.Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age[J].JPediatr Urol,2014,10(5):819-823.
[31]Luck R,Tredway T,Gerard J,et al.Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations[J].Pediatr Emerg Care,2013,29(6):691-695.
[2]段学宁.乳腺良性疾病诊治共识与争议[J].中国实用外科杂志,2016,11(7):713-715.
[3]李杨.乳房应用美学与乳房多位点、多类型微创化手术的临床应用研究[D].长春:吉林大学,2012.
[4]Khansa I,Harrison B,Janis JE.Evidence-based scar management[J]Plast Reconstr Surg,2016,138:165S-178S.
[5]Regula CG,Yag-Howard C.Suture products and techniques[J]Dermatol Surg,2015,41(Suppl 10):S187-S200.
[6]Yag-Howard C.Sutures,needles,and tissue adhesives:a review for dermatologic surgery[J].Dermatol Surg,2014,40(Suppl 9):S3-S15.
[7]Zhang X,Diao J,Guo S,et al.Wedge-shaped excision and modified vertical mattress suture fully buried in a multilayered and tensioned wound closure[J].Aesthetic Plast Surg,2009,33(3):457-460.
[8]张志愿.口腔颌面外科学[M].7版.北京:人民卫生出版社,2012:39-43.
[9]李世荣.现代整形美容外科学[M].北京:人民军医出版社,2014:251-252.
[10]Branham G.Thomas面部美容整形:面部软组织整形[M].北京:人民卫生出版社,2017:27-29.
[11]Thompson CM,Sood RF,Honari S,et al.What score on the Vancouver Scar Scale constitutes a hypertrophic scar?Results from a survey of North American burn-care providers[J].Burns,2015,41(7):1442-1448.
[12]Duncan JAL,Bond JS,Mason T,et al.Visual analogue scale scoring and ranking:a suitable and sensitive method for assessing scar quality?[J].Plast Reconstr Surg,2006,118(4):909-918.
[13]van de Kar AL,Corion LUM,Smeulders MJC,et al.Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale[J].Plast Reconstr Surg,2005,116(2):514-522.
[14]Draaijers LJ,Tempelman FRH,Botman YAM,et al.The patient and observer scar assessment scale:a reliable and feasible tool for scar evaluation[J].Plast Reconstr Surg,2004,113(7):1960-1965.
[15]刘宗辉,舒茂国,刘翔宇.整形外科皮肤缝合技术的特点及应用[J].中国美容医学,2017,26(7):136-139.
[16]Moody BR,McCarthy JE,Linder J,et al.Enhanced cosmetic outcome with running horizontal mattress sutures[J].Dermatol Surg,2005,31(10):1313.
[17]Wang AS,Kleinerman R,Armstrong AW,et al.Set-back versus buried vertical mattress suturing:Results of a randomized blinded trial[J].JAm Acad Dermatol,2015,72(4):674-680.
[18]Yang J,Kim KH,Song YJ,et al.Cosmetic outcomes of cesarean section scar;subcuticular suture versus intradermal buried suture[J].Obstet Gynecol Sci,2018,61(1):79.
[19]Koonce SL,Eck DL,Shaddix KK,et al.A prospective randomized controlled trial comparing N-butyl-2 cyanoacrylate(Histoacryl),octyl cyanoacrylate(Dermabond),and subcuticular suture for closure of surgical incisions[J].Ann Plast Surg,2015,74(1):107-110.
[20]Blondeel PN,Richter D,Stoff A,et al.Evaluation of a new skin closure device in surgical incisions associated with breast procedures[J].Ann Plast Surg,2014,73(6):631-637.
[21]Richter D,Stoff A,Ramakrishnan V,et al.A comparison of a new skin closure device and intradermal sutures in the closure of full-thickness surgical incisions[J].Plast Reconstr Surg,2012,130(4):843-850.
[22]Parvizi D,Friedl H,Schintler MV,et al.Use of 2-octyl cyanoacrylate together with a self-adhering mesh(Dermabond Prineo)for skin closure following abdominoplasty:an open,prospective,controlled,randomized,clinical study[J].Aesthetic Plast Surg,2013,37(3):529-537.
[23]Regan T,Lawrence N.Comparison of poliglecaprone-25 and polyglactin-910in cutaneous surgery[J].Dermatol Surg,2013,39(9):1340-1344.
[24]Kang X,Zhao L,Leung F,et al.Delivery of instructions via mobile social media app increases quality of bowel preparation[J].Clin Gastroenterol Hepatol,2016,14(3):429-435.
[25]Son D,Harijan A.Overview of surgical scar prevention and management[J].J Korean Med Sci,2014,29(6):751-757.
[26]Zide MF.Scar revision with hypereversion[J].J Oral Maxillofac Surg,1996,54(9):1061-1067.
[27]Alam M,Goldberg LH.Utility of fully buried horizontal mattress sutures[J].J Am Acad Dermatol,2004,50(1):73-76.
[28]Quinn J,Wells G,Sutcliffe T,et al.Tissue adhesive versus suture wound repair at 1 year:randomized clinical trial correlating early,3-month,and1-year cosmetic outcome[J].Ann Emerg Med,1998,32(6):645-649.
[29]Park YJ,Kim SJ,Song HS,et al.Prevention of thyroidectomy scars in Asian adults with low-level light therapy[J].Dermatol Surg,2016,42(4):526-534.
[30]Simforoosh N,Abedi A,Hosseini Sharifi SH,et al.Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age[J].JPediatr Urol,2014,10(5):819-823.
[31]Luck R,Tredway T,Gerard J,et al.Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations[J].Pediatr Emerg Care,2013,29(6):691-695.