腹股沟疝合并肝硬化的治疗分析:附30例报告

Treatment of ingunal hernia associated with liver cirrhosis:an analysis of 30 cases

目的探讨腹股沟疝合并肝硬化患者的围手术期处理及治疗原则。方法回顾性分析30例腹股沟疝合并肝硬化手术患者的临床资料。急诊手术5例,择期手术25例;其中传统修补术9例,无张力修补术21例。结果男28例,女2例,中位年龄48(31～79)岁;单侧腹股沟斜疝24例,单侧腹股沟直疝4例,双侧腹股沟斜疝2例;肝功能Child-Pugh A级9例,B级19例,C级2例。手术均成功,术后切口感染2例,阴囊积液2例,切口疼痛和异物感2例;肝功能Child-Pugh C级2例中术后发生轻度肝性脑病1例,肝功能衰竭死亡1例。术后随访6～36个月,1例失访,2例复发结论腹股沟疝合并肝硬化患者应尽早手术,术后能明显提高生活质量。对于肝功能较差者,加强围手术期处理是治疗成功的关键。

Objective To investigate the preoperative management and principles of therapeutic of inguinal hernia in patients with liver cirrhosis.Methods The clinical data of 30 patients with inguinal hernia and liver cirrhosis were analyzed retrospectively.Five cases had emergency operation and 25 had elective operation;9 cases were treated by conventional inguinal hernia repair and 21 cases were treated by tension-free inguinal herniorrhaphy.Results The data included 28 male patients and 2 female patients with median age of 48 years（31-79 years）.Of the patients,24 cases were unilateral indirect hernias,4 cases were unilateral direct hernias and 2 cases were bilateral indirect hernias.The Child-Pugh grades of liver function were grade A（9 cases）,grade B（19 cases）,and grade C（2 cases）.The operation was performed successfully in all patients.Postoperative wound infection occurred in 2 patients,scrotal hydrocele occurred in 2 patients,incision pain and foreign-body sensation occurred in 2 patients.Of the 2 patients in Child-Pugh grade C,1 developed mild hepatic encephalopathy and 1 died of liver failure.During the period of 6 to 36 months of follow-up,1 case lost contact and 2 cases experienced recurrence.Conclusions Inguinal hernia in patients with liver cirrhosis should be treated as soon as possible and surgical treatment can improve the patients′ life qualities.Proper preoperative management is crucial to the patients with poor liver function.