无肠坏死腹股沟嵌顿疝腹膜前间隙Ⅰ期修补可行性的临床观察

Feasibility of single-stage transabdominal preperitoneal repair forincarcerated inguinal hernia without intestinal necrosis

目的探讨无肠坏死腹股沟嵌顿疝腹膜前间隙行I期修补的可行性。方法对无坏死肠嵌顿疝30例（肠嵌顿组）、网膜嵌顿疝18例（网膜嵌顿组）及择期行腹股沟疝修补术30例（对照组），采用腹膜前间隙补片修补术，检测3组术前D-乳酸、内毒素水平及术前、术后第3天白细胞及中性粒细胞计数；观察嵌顿疝患者局部疝囊内渗液细菌培养及术后并发症情况。结果3组术前血浆D哥L酸[分别为（11．7550±3．0391）mg／L，（12．8453±3．0457）mg／L，（11．9056±2．6754）mg／L]及内毒素[分别为（0．5623±0．0893）EU／ml，（0．6137±0．0725）EU／ml，（0．5861±0．0820）EU／m1]比较，差异有统计学意义（P〉0．05）；嵌顿疝患者疝囊囊液细菌培养均为阴性；肠嵌顿组及网膜嵌顿组术前出现白细胞及中性粒细胞增高[分别为（9．22±1．471）×10^9／L、（6．03±1．403）×10^9／L，和（8．87±1．711）×10^9／L、（6．26±1．364）X10^9／L]，与对照组[（6．00±1．054）X10^9／L）、（3．67±0．783）×10^9/L]比较，差异有统计学意义（P〈0．05），但肠嵌顿组及网膜嵌顿组之间比较差异无统计学意义。术后第3天肠嵌顿组及网膜嵌顿组白细胞及中性粒细胞均下降至正常水平[分别为（5．67±1．052）×10^9／L、（3．663±0．557）×10^9／L，（5．53±0．684）×10^9／L、（3．600±0．555）×10^9／L]，与对照组比较[（5．23±1．028）×10^9／L、（3．36±0．544）×10^9／L]，差异无统计学意义。结论对于腹股沟嵌顿疝，需要采取个体化治疗，如果术中发现为网膜嵌顿或肠管嵌顿但尚未发生肠坏死者，I期行腹膜前间隙修补术是安全有效的。

Objective To investigate the feasibility of single-stage transabdominal preperitoneal- repair in incarcerated inguinal hernia without intestinal necrosis. Methods Transabdominal preperito- nealmeshrepair was performed in 30 cases of incarcerated intestine without intestinal necrosis, 18 cases of incarcerated omentum, and 30 cases of inguinal hernia. The levels of preoperative D-lactic acid and endo- toxin and the number of leukocytes and neutrophilsbefore and after operation were recorded. Results of bacterial culture ofthe cyst fluid fromincarcerated hernia and postoperative complications were also com- pared. Results There were no significant differences in the levels of D-lactic acid [ （ 11. 7550 ± 3. 0391 ） mg/L; （ 12. 8453 ± 3. 0457 ） mg/L; （ 11. 9056 ± 2. 6754） mg/L] and endotoxin [ （0. 5623 ± 0. 0893 ） EU/ml; （0. 6137 ±0. 0725）EU/ml; （0. 5861 ±0. 0820） EU/ml] in the three groups before operation （ P 〉 0.05 ） ; the result of bacterial culture of the cyst fluid from incarcerated herniawas negative ; the num- ber of leukocytes and neutrophils wassignificantly increased in the incarceratedintestinegroup [ （ 9.22 ±_ 1. 471 ） × 10^9/L, （6.03 ± 1. 403 ） × 10^9/L） ] andincarceratedomentumgroup [ （ 8.87 ± 1.711 ）×10^9/L, （6.26 ± 1. 364） × 10^9/L）] compared with the inguinal hernia group [ （6. 00 ± 1. 054） × 10^9/L, （3.67 ± 0. 783） × 10^9/L） ]. On the third day after operation, the number of leukocytes and neutrophils returned to normal in the incarcerated groups and there were no significant differences in the incarcerated- intestine group [ （5.67 ± 1. 052） x 109/L, （ 3. 663 ± 0. 557 ） × 10^9/L） ], incarcerated omentum group [ （5.53 ±0.684） × 10^9/L, （3.600 ±0.555）× 10^9/L） ] ,and inguinal hernia group [ （5.23 ± 1. 028） × 10^9/L, （ 3.36 ± 0. 544 ） × 10^9/L） 1. Conclusion Incarcerated inguinal hernia requires individualized treatment. If there are incarceratedomentum or intestine and nonecrosis occurs, single-stage transabdominal preperitoneal repaircan be considered as a safe and effective choice.