腹股沟疝无张力修补术后补片感染再手术处理方法的研究

The reoperation treatment for mesh infection after tension-free repair of inguinal hernia

目的探讨腹股沟疝修补术后补片感染再手术处理的方法和经验。方法回顾性分析重庆医科大学第一附属医院血管疝外科2014年1月-2016年5月收治的34例腹股沟疝修补术后补片感染术后疗效及随访。结果34例患者均成功去除感染补片，其中1例患者因术前合并复发疝，使用生物材质补片进行一期修补，剩余33例未再放置补片，开放切口，充分引流及换药处理，再行切口二期缝合。术后所有患者伤口均为一期愈合，无皮下积液或积脓、再次感染，术后住院时间20-55d，术后平均住院时间29d，术后33例患者获得随访，随访时间为6-26个月，平均随访时间16个月，随访期间1例患者于随访6个月出现同侧腹股沟疝复发，1例患者随访8个月后出现同侧腹股沟区脓肿形成，剩余病例随访过程中未发现皮下积液或窦道形成、腹股沟区脓肿、肠瘘、复发及术后疼痛等并发症。结论腹股沟疝修补术后补片感染的处理较复杂，去除补片，切除感染灶，充分引流等综合治疗方式可得到较好的临床治疗效果及预后，同时也是处理该类病例的有效措施。

OBJECTIVE To detect the reoperation treatment for mesh infection after tension-free repair of inguinal herni- a. METHODS Collected the clinical data of 34 eases of mesh infection after tension-free repair that treated in department of vascular and hernia surgery of the first affiliated hospital of Chongqing medical university from January, 2014 to March, 2016, and analyzed the postoperative outcome retrospectively. RESULTS All of patients were removed the infected mesh successfully by surgical methods. Among the patients, 1 case was repaired by using biological mesh for its recurrent hernia, and the remaining without using mesh, but keep open incision and drainage, secondary suture the incision. All of the cases got primary wound healed, without postoperative subcutaneous effusion and abscess, or secondary infection. The postoperative hospital stays were 20 - 55 days with an average of 29 days, there were 33 cases followed up with 6 - 26 months with an average of 16 months. During the follow up, 1 patient occurred ipsilateral recurrent hernia in 6 months, and 1 case found ipsilateral inguinal region abscess formation in 8 months, the remaining cases without the complication of subcutane- ous effusion or fistula formation, inguinal groin pain, intestinal fistula, abscess and recurrence postoperatively. CONCLUSION It is difficult to treat the mesh infection after tension-free repair of inguinal hernia; we could get better outcome by removing infected mesh or site, drainage or some comprehensive treatment.