嵌顿性腹股沟疝合并肾病综合征患者的围手术期处理

Perioperative management for patients with incarcerated inguinal hernia associated with nephrotic syndrome

目的探讨嵌顿性腹股沟疝合并肾病综合征患者的围手术期处理和安全性。方法 17例(21侧)嵌顿性腹股沟疝合并肾病综合征患者,均采用标准传统腹股沟疝修补术,其中Fer—guson手术7例,Bassini手术5例,Halsted手术2例,McVay手术2例,Shouldice手术1例。合并肠切除、肠吻合手术者4例。结果患者无围手术期死亡,术后无严重并发症发生,术后出现切口感染2例,阴囊水肿3例,给予换药、理疗4天后缓解,术后慢性疼痛1例。术后平均随访10个月,复发1例。结论嵌顿性腹股沟疝合并肾病综合征患者由于合并症较多且复杂,使得手术风险大,难度高,作好充分的术前准备,采用恰当的手术方式,术中谨慎、细致操作,针对性的处理术后出现的各种问题,仍是安全可行的。

Objective To investigate the perioperative practice and safety for patients with incarcerated inguinal hernia associated with nephrotic syndrome. Methods A total of 17 patients（21 sides） withnephrotic syndrome and incarcerated inguinal hernia repair were included. All the surgical methods are traditional inguinal hernia repair, including 7 cases of Ferguson surgery, 5 cases of Bassini surgery, 2 cases of Halsted surgery ,2 cases of McVay surgery, and 1 case of Shouldice surgery. Four cases underwentadditional bowel resection and intestinal anastomosis. Results No perioperative deathor serious complication occurred. Twopatients had incision infection and three patients had scrotal edema. They recovered after dressing change and physiotherapy. One patient had chronic pain after surgery. One patient had a recurrence within the mean follow-up period of 10 months. Conclusion Patients with incarcerated inguinal hernia associated with nepbrotic syndrome are at riskof multiple postoperative complications. However,it is safe and feasible with sufficient preoperative preparation, careful intraoperativeactions and targeted postop- erative management.