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中华胸部外科电子杂志 ›› 2026, Vol. 13 ›› Issue (01) : 14 -27. doi: 10.3877/cma.j.issn.2095-8773.2026.01.02

论著

胸腔镜术后切口缝合及引流管固定方式改进的临床研究
王继林1, 李文洁1, 何准2,()   
  1. 1272000 济宁,济宁医学院临床医学院
    2272029 济宁,济宁医学院附属医院胸外科
  • 收稿日期:2025-12-19 修回日期:2026-01-20 接受日期:2026-02-15 出版日期:2026-02-28
  • 通信作者: 何准
  • 基金资助:
    济宁市重点研发计划(2023YXNS149)

Clinical study on improved methods for postoperative incision suturing and drainage tube fixation following thoracoscopic surgery

Jilin Wang1, Wenjie Li1, Zhun He2,()   

  1. 1Clinical Medicine School, Jining Medical University, Jining 272000, China
    2Department of Thoracic Surgery, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2025-12-19 Revised:2026-01-20 Accepted:2026-02-15 Published:2026-02-28
  • Corresponding author: Zhun He
引用本文:

王继林, 李文洁, 何准. 胸腔镜术后切口缝合及引流管固定方式改进的临床研究[J/OL]. 中华胸部外科电子杂志, 2026, 13(01): 14-27.

Jilin Wang, Wenjie Li, Zhun He. Clinical study on improved methods for postoperative incision suturing and drainage tube fixation following thoracoscopic surgery[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2026, 13(01): 14-27.

目的

探讨胸腔镜术后切口缝合及引流管固定方式改进的安全性及可行性。

方法

纳入2025年1月至2026年1月因肺部或纵隔疾病行胸腔镜手术治疗的患者210例,根据切口缝合及引流管固定方式的不同分为组1、组2、组3。组1(70例)接受双层倒刺线分层缝合结合同切口内深层组织缝合线结下固定置管(方式1);组2(70例)接受双层倒刺线分层缝合结合独立于切口外的Trocar孔道固定置管(方式2);组3(70例)接受传统间断缝合结合同切口皮肤层固定置管(方式3)。分析比较三组患者的切口愈合时间、术后总引流量、术后前3天疼痛视觉模拟评分(VAS)、术后1个月瘢痕评分[温哥华疤痕量表(VSS)与观察者瘢痕评估量表(OSAS)]及术后切口并发症发生率。

结果

共185例患者纳入研究,组1(58例),组2(62例),组3(65例)。组1、组2的瘢痕评分(OSAS、VSS)及线结反应、切口早期感染、皮下气肿、切口愈合不良等并发症的发生率差异无统计学意义(P>0.05),但两组均低于组3(P<0.05)。在切口渗液发生率或切口愈合天数上,组2<组1<组3(P<0.05)。对于第1、2天VAS疼痛评分,组1<组3<组2(P<0.05)。三组之间在第3天VAS疼痛评分(P>0.05)、术后总引流量(P>0.05)及脂肪液化(P>0.05)、脱管(P>0.05)等并发症发生率的差异均没有统计学意义。

结论

方式1及方式2相比于传统缝合固定方式具有更好的安全性和有效性,降低了相关切口并发症的发生率,改善了瘢痕的过度增生,促进了切口的一期愈合,其中方式2尤其在减少切口渗液发生率、加速切口愈合时间方面更具优势,但是在术后患者的疼痛控制方面较差,仍需进一步探索改善。综上所述,本研究所提出的前两种缝合固定方式在特定环境下的临床实际中是有效可行并值得应用的。

Objective

To investigate the safety and feasibility of improving incision suture and drainage tube fixation after thoracoscopic surgery.

Methods

A total of 210 patients who underwent thoracoscopic surgery for pulmonary or mediastinal diseases from January 2025 to January 2026 were prospectively included. They were divided into Group 1, Group 2, and Group 3 according to the different incision suture and drainage tube fixation methods. Group 1 (70 patients) received layered suture with double-layer barbed suture combined with fixation under the suture of the deep tissue within the incision (method 1); Group 2 (70 patients) received layered suture combined with fixation in the Trocar tunnel independent of the incision (method 2); Group 3 (70 cases) received traditional interrupted suture combined with fixed catheter placement at the same incision skin layer (method 3). The incision healing time, total postoperative drainage volume, pain Visual Analog Score (VAS) in the first 3 days after surgery, scar score [Vancouver Scar Scale (VSS) and Observer Scar Assessment Scale (OSAS)] at one month after surgery and the incidence of postoperative incision complications were analyzed and compared among the three groups.

Results

Finally, 185 patients were included in the study—Group 1 (58 patients), Group 2 (62 patients), and Group 3 (65 patients). There were no statistical differences between Group 1 and Group 2 in terms of scar scores (OSAS, VSS) and the incidence of complications such as suture knot reaction, early incision infection, subcutaneous emphysema, and poor incision healing (P>0.05), but both groups were lower than Group 3 (P<0.05). In terms of the incidence of incision exudation or the number of days of incision healing, Group 2 < Group 1 < Group 3 (P<0.05). For postoperative days 1 and 2, the VAS pain scores followed a pattern of Group 1 < Group 3 < Group 2 (P<0.05). There were no statistically significant differences among the three groups on postoperative day 3 (P>0.05), nor in total postoperative drainage volume (P>0.05) or the incidence of complications such as fat liquefaction (P>0.05) and tube dislodgement (P>0.05).

Conclusions

Compared with traditional suture and fixation methods, methods 1 and 2 have better safety and effectiveness, reduce the incidence of related incision complications, reduce excessive scar hyperplasia, and promote primary healing of the incision. Among them, method 2 has advantages in reducing the incidence of incision exudation and accelerating incision healing time, but it has poor postoperative pain control, and still needs further exploration and improvement. To sum up, the first two suture and fixation methods proposed in this study are effective, feasible and worthy of application in clinical practice in specific environments.

图1 方式1的切口缝合固定示意图(A)及效果图(B)。a:皮肤层缝合起始;b:皮内连续缝合;c:绕过胸管;d:末端穿出
图2 方式2的切口缝合固定示意图(A)及效果图(B)
图3 方式3的切口缝合固定示意图(A)及效果图(B)
图4 胸管拔出过程。A:剪断固定线,拔出引流管;B:依次抽紧两层倒刺线
图5 疼痛评分量表
图6 免打结抗菌倒刺线
表1 三组患者基线资料
表2 术后疼痛评分及瘢痕评分比较
表3 各观察指标的亚组分析结果
表4 临床疗效与切口并发症情况比较
图7 术后愈合情况示例
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