腹膜透析患者腹股沟疝修补术的围手术期处理

Perioperative management of patients with peritoneal dialysis and inguinal hernia surgery

目的探讨腹膜透析患者腹股沟疝修补术的围手术期处理和安全性。方法回顾性分析新疆维吾尔自治区人民医院2006年9月至2012年10月收治的腹膜透析患者腹股沟疝修补术19例(26侧),采用无张力疝修补术13例,Ferguson手术2例,Bassini手术4例,针对性的围手术期的处理措施。结果本组患者术后无围手术期死亡,无严重并发症发生,4例切口感染,经换药好转,其中1例3个月后死亡于原发病。2例术后低热,1个月后痊愈。术后均痊愈出院逐渐恢复腹膜透析,随访中位时间22个月,复发3例。3例患者分别于手术后15、20、24个月转为血液透析。结论腹膜透析患者由于医源性腹压增高,腹股沟疝患病率较高。患者行腹股沟疝手术风险大,难度高,但只要作好充分的术前准备,选择好术式,手术谨慎操作,严格围手术期管理,有针对性处理围手术期的各种问题,是安全可行的。

Objective To investigate the perioperative practice and safety of patients with peritoneal dialysis who had inguinal hernia repair. Methods A total of 19 patients who received peritoneal dialysis and inguinal hernia repair were included in the retrospective analysis from September 2006 to October 2012 inclu- ding 13 cases of tension-free hernia repair,2 cases of Ferguson surgery,4 cases of Bassini surgery,and perio- perative treatment measures. Results The patients had no perioperative deaths and serious complications. Four cases had incision infection and were recovered after dressing changes including one dead case due to primary diseases after 3 months. Two cases had postoperative fever and were recovered after one month. All patients were cured and were gradually applied with peritoneal dialysis. The median of follow-up was 22 months. Three recurred patients were found and they received hemodialysis 15 months, 20 months, and 24 months after operation. Conclusions The high prevalence of inguinal hernia is based on the increased iatro- genie abdominal pressure. The surgery of inguinal hernia owns high risks and difficulties. But it is safe and feasible with sufficient preoperative preparation, operation practice, perioperative management, and perioperative actions.