ﻣﻘﺎﻳﺴﺔ ﻧﺘﺎﻳﺞ ﺗﺮﻣﻴﻢ زﺧﻢ آﭘﺎﻧﺪﻛﺘﻮﻣﻲ ﺑﺎ ﺑﺨﻴﻪ ﺑﻪ دو روش Mattress و Subcuticular

Closure of Appendectomy Wound Comparing 2 Methods: Subcuticular and Mattress Suture

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺷﺎﻳﻌﺘﺮﻳﻦ ﻋﻠﺖ ﺷﻜﻢ ﺣﺎﺩ، ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﺍﺳﺖ ﻭ ﺗﻨﻬﺎ ﺩﺭﻣﺎﻥ ﻣﺆﺛﺮ ﺁﻥ ﺁﭘﺎﻧﺪﻛﺘﻮﻣﻲ ﻣﻲ ﺑﺎﺷﺪ. ﺑﻴﻤﺎﺭﺍﻥ ﭘﺲ ﺍﺯ ﺁﭘﺎﻧﺪﻛﺘﻮﻣﻲ ﺍﺯ ﻇﺎﻫﺮ ﻧﺎﻣﻄﻠﻮﺏ ﺍﺳﮑﺎﺭ، ﺁﺑﺴﻪ ﻭ ﻋﻔﻮﻧﺖ ﺯﺧﻢ ﻣﺤﻞ ﺑﺨﻴﻪ ﺷﺎﻛﻲ ﻣﻲ ﺑﺎﺷﻨﺪ ﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻴﻮﻉ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺩﺭ ﺩﻭﻣﻴﻦ ﻭ ﺳﻮﻣﻴﻦ ﺩﻫﺔ ﻋﻤﺮ، ﺯﺧﻢ ﺁﻥ ﺍﺯ ﻧﻈﺮ ﻣﺴﺎﺋﻞ ﺯﻳﺒﺎﺋﻲ ﺣﺎﺋﺰ ﺍﻫﻤﻴﺖ ﻣﻲ ﺑﺎﺷﺪ. ﻫﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ، ﻣﻘﺎﻳﺴﻪ ﻧﺘﺎﻳﺞ ﺗﺮﻣﻴﻢ ﺯﺧﻢ ﻋﻤﻞ ﺁﭘﺎﻧﺪﻛﺘﻮﻣﻲ ﺑﺎ ﺩﻭ ﺭﻭﺵ Subcuticular Suture ﻭ Mattress Suture ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﺔ ﺗﺤﻠﻴﻠـﻲ ﮐﻪ ﺑﻪ ﺭﻭﺵ ﻣﻘﻄﻌـﻲ ﻭ ﺑﻪ ﺻـﻮﺭﺕ ﮐﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨـﻲ ﮐﻨﺘـﺮﻝ ﺷـﺪﻩ ﺻﻮﺭﺕ ﮔـﺮﻓﺘﻪ ﺍﺳﺖ، 207 ﺑﻴﻤـﺎﺭ ﮐﻪ ﺍﺯ ﻓـﺮﻭﺭﺩﻳﻦ 1384 ﺗﺎ ﺁﺫﺭ ﻣﺎﻩ 1385 ﺑﺎ ﺗﺸﺨﻴـﺺ ﺑﺎﻟﻴﻨﻲ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﺩﺭ ﺑﺨﺶ ﺟـﺮﺍﺣﻲ ﻳﮑﻲ ﺍﺯ ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ ﻫﺎﻱ ﺷﻬﻴﺪ ﺻﺪﻭﻗﻲ، ﻣـﺮﺗﺎﺽ ﻭ ﺳﻴﺪﺍﻟﺸﻬﺪﺍﺀ ﻳﺰﺩ، ﺗﺤﺖ ﺁﭘﺎﻧﺪﻛﺘﻮﻣﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ ﺑﻪ ﺭﻭﺵ ﮐـﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﮐﻨﺘـﺮﻝ ﺷﺪﻩ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺍﻟﻒ: )(Subcuticular ﻭ ﺏ: )Mattress( ﻣـﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﻭ ﻣﻘﺎﻳﺴﻪ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﻭ ﺑﻴﻤـﺎﺭﺍﻥ ﺗﺎ 3 ﻣﺎﻩ ﺑﻌـﺪ ﺍﺯ ﻋﻤـﻞ ﻃﻲ 4 ﻣﺮﺣﻠﻪ، ﺍﺯ ﻧﻈﺮ ﺑﻴﺸﺘـﺮﻳﻦ ﭘﻬﻨـﺎﻱ ﺍﺳﻜﺎﺭ، ﻋﻔـﻮﻧﺖ ﺯﺧﻢ ﻭ ﺁﺑﺴﻪ ﻣﺤﻞ ﺩﺭ ﻣﻄﺐ ﺟﺮﺍﺡ ﭘﻴﮕﻴـﺮﻱ ﺷﺪﻧﺪ. ﺍﻃﻼﻋﺎﺕ ﺑﻪ ﺩﺳﺖ ﺁﻣـﺪﻩ ﺗﻮﺳـﻂ ﺑﺮﻧﺎﻣﻪ ﺭﺍﻳﺎﻧﻪ ﺍﻱ SPSS 11.5 ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺁﺯﻣﻮﻥ ﺁﻣﺎﺭﻱ ANOVA ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻗـﺮﺍﺭ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴـﻦ ﭘﻬﻨـﺎﻱ ﺍﺳﻜﺎﺭ ﺩﺭ ﮔـﺮﻭﻩ ﺍﻟﻒ: )(Subcuticular 0/96 ﻣﻴﻠﻲ ﻣﺘـﺮ ﻭ ﺩﺭ ﮔـﺮﻭﻩ ﺏ: )Mattress( 7 ﻣﻴﻠﻲ ﻣﺘﺮ ﺑﻮﺩ، ﻛﻪ ﺑﺎ 0/0001= P-Value ﺍﺯ ﻧﻈـﺮ ﺁﻣـﺎﺭﻱ ﺩﺍﺭﺍﻱ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﻣﻲ ﺑﺎﺷـﺪ. ﺩﺭ ﻣـﻮﺭﺩ ﺁﺑﺴﻪ ﻣﺤﻞ ﺳﻮﭼـﻮﺭ، ﺗﻨﻬﺎ ﻳﻚ ﻣـﻮﺭﺩ ﺁﺑﺴﻪ ﻣﺤﻞ ﺳﻮﭼـﻮﺭ )ﻣﻌـﺎﺩﻝ 0/8 ﺩﺭﺻﺪ( ﻭ ﺁﻥ ﻫـﻢ ﺩﺭﮔـﺮﻭﻩ ﺍﻟﻒ ﺩﻳـﺪﻩ ﺷﺪ، ﺩﺭ ﺣﺎﻟـﻲ ﻛﻪ ﺩﺭ ﮔـﺮﻭﻩ ﺏ ﻫﻴـﭻ ﻣـﻮﺭﺩﻱ ﺍﺯ ﺁﺑﺴﻪ ﮔـﺰﺍﺭﺵ ﻧﺸـﺪ ﻛﻪ ﺍﻳﻦ ﺗﻔـﺎﻭﺕ ﺑﺎ 0/45= P-Value ﺍﺯ ﻧﻈـﺮ ﺁﻣﺎﺭﻱ ﻣﻌﻨـﻲ ﺩﺍﺭ ﻧﻤﻲ ﺑﺎﺷـﺪ. ﺩﺭ ﻫﻴـﭻ ﮐـﺪﺍﻡ ﺍﺯ ﮔـﺮﻭﻩ ﻫﺎ، ﻣـﻮﺭﺩﻱ ﺍﺯ ﻋﻔـﻮﻧﺖ ﺯﺧﻢ ﮔﺰﺍﺭﺵ ﻧﺸـﺪ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌـﻪ، ﻓﺎﻛﺘـﻮﺭﻫﺎﻱ ﺳﻦ ﻭ ﺟﻨﺲ ﻣﺘﻐﻴـﺮ ﻣﺨـﺪﻭﺵ ﮔﺮ ﺑﻮﺩﻧـﺪ ﻛﻪ ﺑﺎ ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﺁﻧﺎﻟﻴـﺰ ﻛﻮﻭﺍﺭﻳﺎﻧﺲ ﺍﺻﻼﺡ ﻭ ﻛﻨﺘﺮﻝ ﺷﺪ.

Introduction & Objective: Acute appendicitis is the most common cause of acute abdomen. Appendectomy is only curative treatment for acute appendicitis. The patients, after appendectomy complain from ugly configuration of suture site, scar problem is stitch abscess and wound infection after appendectomy. This is aesthetically important, because appendicitis is prevalent in the second and third decades of life. This study compared wound closure result by two methods; Subcuticular and Mattress suture. Materials & Methods: In this analytic, clinical trial, 207 patients (105 group A and 102 group B) with the initial diagnosis of appendicitis were appendectomised at Shahid Sadooghi, Mortaz and Saidoshohada hospitals, from April 2005 to December 2006. In 4 follow up visit, patients were clinically examed for Maximum of wound scar width, wound infection and stitch abscess to 3 months after appendectomy at the clinics. Collected data were analyzed with ANOVA test using SPSS11.5 software. Results: The Mean Scar width in Subcuticular group (A) was 0.96 mm and in Mattress group (B) was 7 mm. There was significant difference between two groups (P.Value=0.0001).The Abscess in the Subcuticular group was seen in one case (0.8%) and in the Mattress group no abscess was seen. There was no significant difference between two groups (P.Value = 0.45). There was no case of wound infection in the two groups. In this study, the age and gender factors were confunding and by using co-variance analysis, thay were taken care of. Conclusions: Considering the results of this study, the Subcuticular method is a better option in closure of an appendectomy wound