应用补片治疗脐疝合并肝硬化严重腹水的临床研究

Mesh repair for umbilical hernia in cirrhotic patient with intractable ascites

目的目前,对于肝硬化合并复杂脐疝最适当的治疗方式仍无定论,本研究的目的是评估使用聚丙烯(polypropylene)补片治疗脐疝合并肝硬化严重腹水的临床应用。方法回顾性分析2008年3月至2012年6月,国泰综合医院共收治9例脐疝合并肝硬化严重腹水的患者,均接受补片修补脐疝治疗。9例患者均置放负压密闭式引流管(Jackson-Pratt drain tube)到腹腔内做腹水的减压,每天引流腹水量约1 000 ml,持续1个月。于出院后1个月与6个月追踪复诊。结果手术后3个月复发脐疝1例,原因是补片无法与肚脐的皮肤和腹壁充分粘合。本组患者都没有出现腹膜炎与伤口感染的现象。Jackson-Pratt引流管拔除后的伤口必须用缝线缝合。因为长期大量腹水流失,必须密切检测血清中白蛋白值并补充蛋白质。脐疝修补手术前、后均必须持续使用利尿剂排出腹水。结论应用永久性补片治疗脐疝合并肝硬化严重腹水的患者,并发症少,复发率低。在手术前后使用抗生素治疗并注意无菌技术操作,应用补片治疗肝硬化合并严重腹水的脐疝患者是一种安全、简单而有效的治疗方式。

Objective The optimal management of complicated umbilical hernia in patients with liver cirrhosis is still undefined. The purpose of this study is to evaluate the use of polypropylene mesh in treatment of patients complicated with umbilical bemia. Methods From March 2008 to June 2012, a total of 9 hepatic cirrhotic patient with intractable ascites and umbilical hernia received mesh repair. All the patients were placed a Jackson-Pratt drain in lower abdominal cavity for ascites decompression. The drain tube was placed for one month and the amount of ascites drainage was around 1 000 ml/d. Patients were followed up 1 to 6 months after discharge. Results There was one patient has recurrent umbilical hernia three months later since the mesh did not take with skin of umbilicus. Neither peritonitis nor wound infection occurred in these patients. The wound of Jackson-Pratt drain tube was sutured repair after the drain tube removal. Almost all patients felt general weakness after large amount of ascites loss. The diuretics was reserved before and after the operation of umbilical hernia repair. Conclusions Permanent mesh can be used in cirrhotic patients with minimal wound-related morbidity and complicated with umbilical hernias and a significantly lower rate of recurrence was observed. Elective mesh repair of umbilical hernia with ascites in cirrhotic patients was proved to be a safe, simple and effective technique with perioperative antibiotics and proper aseptic procedure.