无张力疝修补术治疗急性嵌顿性疝210例分析

Clinical analysis of tension free repair in the treatment of 210 cases of incarcerated inguinal hernia

目的探讨无张力疝修补术在急性腹股沟嵌顿疝中临床应用的疗效和可行性。方法回顾性分析2005年12月至2012年11月210例急性腹股沟嵌顿疝行一期无张力疝修补术的临床资料。手术方式包括网塞加补片修补法(Rutkow)42例、超普网塞修补法(UPP)138例、超普疝修补装置(UHS)30例,采用SPSS13.0软件进行统计分析,计数资料比较用χ2检验,P<0.05表示有统计学意义。结果腹股沟嵌顿性疝患者渗出液细菌培养结果显示,嵌顿时间超过12 h的162例病例,渗出液细菌培养阳性38例,阳性率23.5%;嵌顿时间小于12 h的48例病例的细菌检出阳性2例,阳性率4.2%,两组之间差异有统计学意义(χ2=4.217,P<0.05)。术后总并发症发生率2.9%(6/210,血肿3例、出血1例、感染2例,切口感染均为糖尿病患者,无深部补片感染,给予敞开切口引流换药后愈合),3种手术方式并发症发生率差异无统计学意义(χ2=0.188,P>0.05)。210例嵌顿疝患者行一期修补术后1年内复发者1例,复发率为0.5%。结论选择合理手术方法、熟悉腹股沟区局部解剖、熟练掌握疝修补技术,无张力疝修补术在急性腹股沟嵌顿疝中的应用是可行的、安全的。

Objective To inv,：stig^te the clinical efficacy and feasibiiity of tension free repair in the trea＇ment of incarcerated inguinal herma, l~＇~etheds The clinical data of 21O cases of acute incarcerated inguinal hernia, wh! ：h had undergone ：enzion free repair admitted from December 2005 to November 2012 at Anting Hospital, were retrospectively analyzed. Surgical procedure included Rutkow, UPP, and UHS. SPSS 13.0 softwaa＇e was used for stati.qtical analysis, count data were compared with the chi-square test. P 〈 0.05 was considered stat＇stically significant. Results Exudate bacterial culture of cases of incarcerated inguinal hernia showed an incarcerated time for more t!~an 12 hours in 162 cases and 2 cases showed positive bacteria （ 2%. 5% ）Incarcerated time less than 12 was found in 48 cases, with a positive rate of 4.2%. The difference between the two groups was statistically significant （h＇： = 4. 217, P 〈 0.05 ）. The overall incidence of postoperative complications was 2.9% （ 6/210 ）. The complications included hematoma （ 3 cases ） , hemorrhage（I）, and infection（2）. Incisional infection occurred in patients with diabetes mellitus, bm no infection of deep mesh was found. Two cases of infection were cured by open incision and drainage. There was no statist＇cally significant difference （x2 = 0.188, P 〉 0.05 ） in postoperative complications ＇imo, g three kinds of operation. One case of rect, rrence （0.5%） in 210 cases of incarcerated hernia underwent tension free nepair. Conclusion The key points for the prevention of postoperative complications include cQrrect procedure, understanding of inguinal opography and performing hernia repair Icroficiently. Tension repair in the treatment of incarcerated inguinal hernia is safe and feasible.