腹股沟疝无张力修补术后补片感染的诊疗体会

Experience of diagnosis and treatment of postoperative patch infection after repair of inguinal hernia without tension

目的总结腹股沟疝无张力修补术后补片感染的诊疗体会,探讨腹股沟疝术后补片感染的概念、诊断、治疗和预防。方法回顾性分析本院普外科2008年7月~2016年8月收治的14例腹股沟疝充填式无张力修补术后补片感染的临床资料。根据手术史、临床表现、脓液细菌培养、B超或CT可诊断补片感染。入院后患者均行窦道扩创,清除感染补片、感染灶清除和引流术。术后予以换药治疗。结果患者术后住院时间14~45 d,平均(24.5±5.5)d,术后伤口均为二期愈合,住院期间腹股沟疝均未见复发,未再行腹股沟疝修补术,术后11例患者获访,随访时间6~10个月,平均(8.3±1.5)个月,无伤口周围红肿、疼痛、肠瘘等,无疝复发。结论腹股沟疝充填式无张力修补术后应注意观察切口情况,必要时行B超或CT协助诊断。一经诊断明确,应积极手术尽量取出补片,结合伤口换药,使切口愈合。

Objective To summarize the experience of diagnosis and treatment of postoperative patch infection after the repair of inguinal hernia without tension, and to explore the concept, diagnosis, treatment and prevention of postoperative patch infection after the surgery of inguinal hernia. Methods Clinical data of 14 patients with patch infection after the repair of inguinal hernia filling without tension who were admitted to the department of surgery in hospital from July 2008 to August 2016 were retrospectively analyzed. According to the history of surgery, clinical manifestations, pus bacterial culture, B-ultrasound or CT, the patch infection was diagnosed. After admission, the patients were given sinus tract wound debridement, removal of patch infection, infection clearance and drainage. The patients were given dressing after the surgery. Results The postoperative hospital stay was 14-45 days, with an average of(24.5±5.5) d. Postoperative wounds were all stage II healing. There was no recurrence of inguinal hernia during hospitalization. The inguinal hernia repair was not carried out again. 11 patients were followed up for 6 to 10 months after the surgery, with the average of(8.3±1.5) months. There were no swelling around the wound, pain, intestinal fistula, or recurrence of hernia. Conclusion Attention should be paid to incision in the repair of inguinal hernia filling without tension, and if necessary, B-ultrasound or CT should be performed to help diagnosis. Once the diagnosis is confirmed, surgery should be actively carried out to remove the patch, combined with wound dressing, so as to promotion incision healing.