腹壁疝补片修补相关感染：病理学、治疗和结局

Infections associated with prosthetic repairs of abdominal wall hernias:pathology,management and results

目的分析应用合成补片行疝修补后出现需要去除补片的手术部位感染并发症病人的临床及人口统计学特点,补片植入手术的细节以及感染发生后的治疗和结局。方法从病人资料表中获得病人的感染相关因素(人口统计学参数、疝修补术特点和使用的网片)。收集32例连续病例的标本(补片和组织),行细菌培养和显微镜检查。前瞻性评估补片取出后的结局。结果 22例接受了切口疝修补术,10例接受了腹股沟疝修补术,大部分病人手术时间较长,28例出现过早期伤口并发症(浆液肿或血肿)。在"补片植入-取出"间期,部分病人进行了保守治疗,例如局麻下引流或者窦道切除。22例的网片被完全取出(其中9例是补片部分取出后),其余10例部分取出补片治疗有效。大部分补片(24例)是多纤丝聚丙烯网片,补片周围组织的显微镜观察发现有白细胞浸润、巨细胞反应、胶原纤维无序排列以及脓肿形成。32例共进行了51例次手术治疗,补片取出后,有6例复发和2例肠瘘。平均随访时间为40(30～97)个月。结论大多数需要去除补片的感染病例前次疝修补术时间较长,并且有未经治疗的术后早期伤口并发症。补片部分取出通常不会成功,而且会带来并发症。取出全部补片的外科探查手术应该在全麻下进行。

Objective To analyse clinical and demographic factors of patients who suVered infection of the surgical site equiring mesh removal as a complication of prosthetic repairs,details of the hernioplasties in which meshes were implanted and their management and outcomes.Methods Factors related to infection（demographic variables and characteristics of the repairs and mesh utilised） and the management before proceeding to mesh removal were obtained from patient charts.Collected specimens（meshes and tissues） from 32 consecutive patients were cultured and observed microscopically.The outcomes after mesh removal were prospectively evaluated.Results Twenty-two patients underwent incisional hernioplasties and ten inguinal hernioplasties;most of the procedures took a long time,and 28 patients presented early wound complications（seroma or haematoma）.During the ＂implantation-removal＂ interval,some conservative treatments,such as drainages or sinus resection,were attempted under local anaesthesia.Twenty-two meshes were totally removed（nine after partial extraction）;in the remaining ten cases partially removal was successful.Most of the meshes（24） were made of multiWlament polypropylene;microscopic observation of neighbouring tissues showed leucocyte inWltration,giant cell reaction,disorganisation of the collagen Wbres and abscedation.Treatment of 32 patients required 51 operations.Following mesh removal,there were six recurrences and two Wstulas of the bowel.The average follow-up was 40 months（30-97）.Conclusion Most of the infections requiring mesh removal were related to prolonged repair operations that presented untreated early postoperative wound complications.Partial extraction of meshes frequently leads to failures and complications.Surgical exploration should be performed under general anaesthesia to accomplish complete mesh extraction.