假体材料在85例腹股沟疝修补术中临床应用的研究

The clinical study of the use of prosthetic material for 85 patients with inguinal hernia repair

目的探讨假体材料在腹股沟疝急诊手术中应用的可行性及价值。方法对我院2000年1月至2005年7月假体材料在腹股沟疝85例中运用的病例进行回顾性分析。结果85例中71例择期行假体材料修补术后,5例出现阴囊血肿,2例发生腹股沟血肿,3例发生血清肿,1例表皮脓肿,均经局部治疗治愈。14例疝行急诊术网片修补术后出现阴囊血肿3例,腹股沟血肿及腹壁下积液各1例,除1例为肠切除半年内并发肠粘连梗阻经保守治疗治愈外,无一例复发及其他严重并发症。择期手术组和急诊手术组的术后感染率为8.5%(6/71)及14.3%(2/14),两组血肿及感染发生率相比显著无统计学意义(P>0.05)。但两组病例都无须移除网片且无一例复发及其他严重并发症。结论注意术前患者合理的选择、合理的围手术期处理及积极的术中、术后早期抗感染处理,假体材料在腹股沟疝急诊手术中的应用是可行的。其运用能克服传统手术的缺点,缩短患者治疗时间,避免二次手术风险。

Objective To investigate the feasibility and value of the use of prosthetic material for inguinal hernia surgical theatrnent in emergency. Methods 85 patients from January 2000 to July 2005 were treated by the use of prosthetic material for inguinal hernia repair and analyzed retrospectively. Results 85 patients were divided into two groups according to selective or emergency surgery. The selective surgery group （SS group, n = 71） were performed by the use of prosthetic material for inguinal hernia repair in selective surgery. Their postoperative complications included scrotum haematoma （n = 5）, inguinal haematorna （n = 2）, serum tumidness （n = 3,） and epidermis adscess （n = 5）, inguinal haematoma （n = 2）, serum tumidness （n = 3）, and epidermis abscess（n = 1）. The patients with complications were cured by local therapy. The other 14 patients underwent inguinal hernia repair using polypropylene mesh in the emergency surgery group （ES, n = 14）, 3 of which had scrotum haematoma after operation, one had inguinal haematoma and the other had abdominal wall fluidity. They were cured by local treatment. One patient with adhesive small bowel obstruction occurred in half a year after partial small bowel resection was cured by conservative treatment. None recurred and had other severity complications. Postoperative infective rate in the SS group and ES group were 8.5 96 （6/71） and 14.396 （2/14）, respectively. Haematoma rate and infective rate were not significant difference between the two groups （P〉0.05）. Prosthetic material for inguinal henia repair needed not to be removed because of haematoma and infection. Conclusion It should be paid attention to choose the patient before operation, the proper management perioperation, and antibiotic therapy during and after operation. It is feasible to use prosthetic material for inguinal hernia surgical treatment in emergency. Using prosthetic material can overcome the shortcoming of traditional surgical treatment, shorten the therapeutic time and avoid reoperative risk.