肝硬化顽固性腹水合并腹股沟疝的临床治疗分析

The clinical efficiency of Iichtenstein tension-free hernioplasty in patients with inguinal hernia,liver cirrhosis and ascites

目的探讨介绍Lichtenstein无张力疝修补手术治疗肝硬化顽固性腹水合并腹股沟疝的围手术期处理方法,探讨其临床疗效。方法回顾性分析2008年1月至2013年1月,华中科技大学同济医学院附属武汉市中心医院收治肝硬化顽固性腹水合并腹股沟疝患者68例的临床资料,患者均行Lichtenstein无张力疝修补术,其中急诊手术8例,择期手术60例。结果 68例患者手术均获成功,手术修补时间20~70 min,平均（36±16）min;术后住院时间4~14 d,平均（6.0±2.0）d;术后出现阴囊皮肤瘀斑2例,远端疝囊积液3例,伤口感染2例,伤口区腹水渗漏1例,轻度肝性脑病1例,腹壁皮下组织坏死性筋膜炎1例,未见睾丸萎缩、阴囊血肿及上消化道出血发生。术后随访时间12~48个月,患者均获随访,手术侧无复发,对侧新发腹股沟疝5例,随访期内死亡患者2例,与手术治疗不相关。结论 Lichtenstein无张力疝修补手术治疗肝硬化顽固性腹水合并腹股沟疝操作简单,手术范围小。术中有效安全地在内环口将疝囊颈部紧闭,辅助人工材料修补,使腹水不能进入阴囊,这是手术治疗的重要措施。同时,术中保证疝囊近端的完整,避免行腹膜前疝修补术,彻底缝合止血及术后对症处理是手术成功的关键。

Objective To investigate the preoperative management and the clinical efficiency of Lichtenstein tension-free hernioplasty in patients with inguinal hernia, liver cirrhosis and ascites. Methods The clinical data of 68 patients with inguinal hernia and liver cirrhosis, who admitted to The Wuhan Central Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2008 to January 2013, were analyzed retrospectively. All cases were repaired with Lichtenstein technique under local anesthesia, including 8 cases of emergency operation and 60 cases of elective operation. Results The operation was performed successfully in all patients. The operative time was 20 to 70 minutes, with an average time of （36 ＋ 16） minutes, and the postoperative hospitalization time was 4 to 14 days, with an average time of （6.0 ~ 2.0） days. There were 2 cases of skin ecchymosis of the scrotum, 3 cases of hydrops of hernia sac, 2 cases of wound infection, 1 case of peritoneal effusion, 1 case of mild hepatic encephalopathy and 1 case of necrotizing fasciitis after operations. During the period of 12 to 48 months of follow-up, there were no recurrence in operative side, but 5 cases of primary hernia in non-operative side. 2 patients died due to liver failure at 1-year follow-up. Conclusion In the inguinal hernia patients complicated with liver cirrhosis, the Lichtenstein tension-free hernioplasty is simple to perform and has less trauma. The important measures in the treatment include closing the sac neck safely and effectively around the inner ring, and being reinforced with prosthesis, avoiding ascites into the scrotum. At the same time, the integrity of proximal hernia sac and non-preperitoneal hernia repair, completely suture hemostasis and proper postoperative management are the keys to success.